Multiple myeloma in elderly patients: presenting features and outcome

Few studies have been performed regarding multiple myeloma (MM) in elderly patients. We report a retrospective series of 130 unselected patients with MM aged 75 yr or more at diagnosis. Presenting features were identical to t hose reported in younger patients, except for a higher rate of infection. H eavy comorbidity was characteristic of unselected geriatric patients. Ninet y-four patients received conventional chemotherapy. The response rate was 6 2%. Treatment toxicity was mild. Median survival was 22 months. Durie-Salmo n (DS clinical stages II and III MM were severe and often led to death, whi le significantly more patients with DS stage I MM died from unrelated cause s (p < 0.0001). Univariate analysis showed that age <greater than or equal to> 85 yr, performance status greater than or equal to 2, creatinine level greater than or equal to 120 mu mol/l, beta 2 microglobulin level > 4 mg/l, C-reactive protein level > 6 mg/l, platelet count < 100 x 10(9)/l, presenc e of infection and lack of response to chemotherapy were adverse prognostic factors for survival. In Cox multivariate regression analysis, age <greate r than or equal to> 85 yr (p < 0.0001), performance status <greater than or equal to> 2 (p < 0.0001) and creatinine level <greater than or equal to> 1 20 mu mol/l (p < 0.001) were independent factors in predicting short surviv al. This study provides evidence that in patients with symptomatic MM age s hould not be considered as a major obstacle to active treatment. Prospectiv e clinical trials are needed in this population of patients and should incl ude an assessment of quality of life.