TREATMENT OF MULTIPLE-MYELOMA IN ELDERLY PEOPLE - LONG-TERM RESULTS IN 178 PATIENTS

The purposes of the present study have been to analyse the presenting features, response to therapy and survival of myeloma patients aged 70 years or more, in comparison to younger patients. From January 1985 t o December 1989, 487 patients with multiple myeloma (MM) mere randomiz ed to receive melphalan and prednisone (MP) versus alternating cycles of vincristine, cyclophosphamide, melphalan, and prednisone (VCMP) and vincristine, BCNU, adriamycin, and prednisone (VBAP). The subset of 1 78 patients who were 70 or more years is the subject of this study, wh ereas the 309 patients younger than 70 years were used as a control gr oup. The presenting features and response to chemotherapy of older pat ients were no different to those of the younger population. However, t he survival of elderly patients was significantly shorter (median 23.4 vs. 33.5 months, p < 0.001). The overall response rate to MP in older patients was 50% (28% objective plus 22% partial response) compared w ith 61% (44% objective plus 17% partial response) to combination chemo therapy (p = not significant). Myelosuppression was moderate in both a rms, although MP produced a higher degree of thrombocytopenia. There w ere no significant differences in survival between patients given MP v ersus VCMP/VBAP (median, 20 vs. 27 months, p = 0.2). Response to treat ment was associated with a significantly longer survival. Older patien ts with symptomatic myeloma tolerate chemotherapy and should be offere d treatment.