Rohatgi N et al. (2007) Chemotherapy and survival for patients with multiple myeloma: findings from a large nationwide and population-based cohort. Am J Clin Oncol 30: 540–548

Chemotherapy has been shown to prolong survival in patients with multiple myeloma (MM); however, little is known about the impact of chemotherapy on the survival of elderly patients, as this population is under-represented in clinical trials. A study by Rohatgi et al. has assessed the effect of chemotherapy on the survival of patients aged 65 years or older, outside the clinical trial setting.

This retrospective study included 4,902 MM patients with stage II or III disease, 52% of whom received chemotherapy during their disease course. The receipt of chemotherapy decreased substantially with age (65.7% of patients aged 65–69 years old and 34.3% of patients aged 80 years or older received chemotherapy) and was associated with an increased comorbidity score. Compared with white patients, black patients were 23% less likely to receive chemotherapy. Patients who received chemotherapy were 39% less likely to die of MM (adjusted hazard ratio 0.61; range 0.56–0.67) and 35% less likely to die of any cause (adjusted hazard ratio 0.65; range 0.61–0.69) than were those who did not receive chemotherapy. An increase in the number of chemotherapy cycles was associated with a decreased risk of MM-specific and all-cause mortality (P <0.001 for trend), and survival benefit was significant across all age, sex and ethnic groups, and comorbidity scores.

While further studies to confirm these findings in younger patients are needed, this study indicates that chemotherapy is associated with increased survival in patients with MM outside the clinical trial setting.