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Abstract Topic: 35. Quality of life and palliative care
Background: Multimorbidity, which is generally described as the coexistence of two or more chronic diseases, is usually encountered in the elderly population. The therapeutic approach is complicated for the patients with more than one chronic condition for both healthcare professionals and patients, leading to unfavorable health outcomes. Also, management of the patients with these comorbidities, especially the ones with hematological malignancies and using chemo-immunotherapeutic agents, constitutes a difficult clinical point.
Polypharmacy in hematological malignancies is also a research area with very little literature data. Although the median age of diagnosis of several hematological maligancies such as acute myeloid leukemia (AML), multiple myeloma (MM), chronic lymphocytic leukemia (CLL) and myledysplastic syndrome is around 70 years, the elderly patients and those with comorbidities are frequently excluded in clinical trials. So the development of personalized treatment approaches in this patient group is considerable for future needs.
Aims: The aim was to investigate the effects of polypharmacy on treatment response, and survival in elderly patients with different hematological malignancies.
Methods: The data of 91 patients, who were ≥ 60 years old, with the diagnosis of a hematological malignancy of either MM or CLL or lymphoma was analyzed retrospectively. The patients were diagnosed and followed at the University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, between October 2012 and July 2017. The patients who did not receive cytotoxic treatment due to the hematologic malignancy and whose drug history could not be found were excluded from the study.
The data including gender, age, diagnosis, Eastern Cooperative Oncology Group (ECOG) score, stage, treatment regimens, concomitant diseases, drugs used, history of radiotherapy, treatment response of the patients and treatment toxicity were reviewed from the database of the hematology department. Laboratory tests performed to assess biochemical and metabolic status of the patients included the measurements of complete blood count, kidney and liver functions.
Treatment response was evaluated according to Lugano response criteria for lymphoma, International Myeloma Working Group Uniform Response Criteria for multiple myeloma, International Workshop on Chronic Lymphocytic Leukemia for chronic lymphocytic leukemia.
Results: The probability of overall survival (OS) at the end of the follow-up was 36% in patients receiving ≤ 6 drugs, and 46% in patients receiving > 6 drugs (p=0.271). In subgroup analysis regarding the diagnosis of the patients, in multiple myeloma patients; the probability of OS at the end of the follow-up was 37% in patients receiving ≤ 6 drugs and 97% in patients receiving > 6 drugs (p=0.08). In chronic lymphocytic leukemia patients; the probability of OS at the end of the follow-up was 77% in patients receiving ≤ 6 drugs and 100% in patients receiving > 6 drugs (p=0.325). In lymphoma patients; the probability of OS at the end of the follow-up was 61% in patients receiving ≤ 6 drugs and 81% in patients receiving > 6 drugs (p=0.964)
Summary/Conclusion: The polypharmacy is indispensable in a number of old patients with comorbidites, and this situation would not hinder the physicians from treating those patients with the diagnosis of hematological maligancies, at least the indolent types
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Figure 1. The probability of overall survival of at the end of follow-up in patients using concomitant drugs ≤ 6 and >6 (p=0.271 )
Keywords: Survival, Treatment, Prognosis