P191 | MAIN BIOLOGIC AND CLINIC FEATURES AT PRESENTATION AND TREATMENT RESULTS IN VERY ELDERLY PATIENTS (> 75 YEARS) WITH MULTIPLE MYELOMA: THE VITERBO EXPERIENCE

Multiple Myeloma (MM) is often diagnosed in patients (pts) aged > 75 years. These very elderly subjects are under-represented in clinical controlled trials, with a diagnostic work-up reduced in comparison to younger pts, especially from a biologic point of view. In addition, a wide range of less intensive therapies is employed according to responsible physician decision. In the present real-life study, clinic and biologic features, treatment choice and treatment results in all consecutive pts aged > 75 years newly diagnosed with symptomatic MM according to SLIM-CRAB criteria at our Center in a 6-year period were collected. From 1/2018 to 12/2023, 26 pts with newly diagnosed symptomatic MM were observed. Pts characteristics at diagnosis are reported in the Table. Karyotype with FISH analysis was available in 23 pts (88.5%): 8 pts (34.8%) had a normal karyotype, while 15 pts (65.2%) had at least one alteration. The most common alterations were del(13q) in 6 pts and gain/ampl(1q) in 4 pts: among high risk alterations, t(4;14) and del(17p) were present in 2 pts each. Twenty-one pts received VMP scheme, 3 pts Dara-RD and 1 pt each Dara-VP and MP. Fourteen pts (53.8%) received treatment in Day-Hospital setting, while 12 pts (46.2%) were managed at home by the Domiciliar Hematologic Care Unit (DHCU) available in the Viterbo province. Three pts achieved a complete remission (CR), 7 pts a very good partial remission (VGPR) and 10 pts a partial remission (PR), with an overall response rate (ORR) of 76.9%: five pts had a stable disease (SD) and one pt a disease progression (DP). A 2nd line treatment was needed in 14 pts, after a median time from 1st line of 20.2 months (IQR 15.1 – 38.9): Dara-RD was employed in 8 pts, RD in 4 pts, VCD and MP in one pt each, achieving 2 CR, 5 VGPR and 2 PR, with an ORR of 64.3%. At the last follow-up, 19 pts are alive, 1 pt was lost to follow-up and 6 pts died (5 from disease progression, 1 from sudden death while in VGPR). Five-year overall survival was 64.1% (95%CI 36.6 – 91.6).Our real-life data suggest that very elderly pts with newly diagnosed MM can have a good response to current treatments with a relatively long survival, and should be considered for the best available approaches irrespective from the age. In this setting, a DHCU can facilitate the management of frailer pts, otherwise often excluded by effective treatments. A larger cohort is needed to evaluate the prognostic role of clinic/biologic features in this context.