Clinical outcomes in older adults treated outside clinical studies: highlighting the octogenarian experience

With an aging population, multiple myeloma (MM) increasingly affects octogenarians (Octos; age of ≥80 years), yet data on their management and outcomes, particularly if treated outside clinical trials, remain limited. This retrospective study analyzed 652 patients aged ≥70 years, diagnosed with active MM between 2014 and 2023, identified in the Maccabi Healthcare Services medical records. Patient characteristics, treatment, time to next treatment (TTNT), overall survival (OS), and factors influencing outcomes, were compared between Octo and older adults (OL) aged 70 to <80 years. Octo patients (median age, 83 years) had more comorbidities and higher Charlson Comorbidity Index (CCI) scores than OL patients (≥6; 53% vs 23%), leading to lower rates of anti-MM therapy administration and reduced triplet/ quadruplet regimen use. Over a median follow-up of 25 months, Octo patients had significantly shorter median OS; 25.9 vs 71.3 months, and 33 vs 76.9 months among treated patients only. TTNT was similar (17.8 vs 22.1 months). Multivariate analysis showed that triplet/quadruplet regimen was associated with improved TTNT (hazard ratio [HR], 0.61; P < .001) and OS (HR, 0.63; P < .001) compared with doublets, whereas higher CCI scores and age of ≥80 years predicted worse OS (HR, 1.5; P = .003; and HR, 2.27; P < .001; respectively). Daratumumab-based therapies enhanced TTNT in both age groups (HR, 0.54; P = .017). In conclusion, higher comorbidities in Octo patients adversely affected their management and survival. However, daratumumab positively influenced outcomes, underscoring the need for tailored approaches to optimize treatment in older patients with MM.