Does polypharmacy affect survival in older patients with haematological malignancy?

Polypharmacy does not appear to result in poorer treatment response and survival in older patients with different haematological malignancies, as shown in a study presented at the recent EHA 2023.

“[P]olypharmacy is indispensable in a number of old patients with comorbidities, and this situation would not hinder the physicians from treating those patients with the diagnosis of haematological malignancies, at least the indolent types,” according to the researchers, led by Kadir Karışmaz from T C Saglik Bakanligi Istanbul Egitim Ve Arastirma Hastanesi, Istanbul, Turkey.

Karışmaz and his team retrospectively analysed the data of 91 patients (aged ≥60 years) with multiple myeloma (MM), chronic lymphocytic leukaemia (CLL), or lymphoma. Patients were diagnosed and followed at the University of Health Science, Istanbul Training and Research Hospital between October 2012 and July 2017.

Those who did not receive cytotoxic treatment due to the haematologic malignancy and had no drug history were excluded from the analysis.

The research team then reviewed the data, including age, gender, diagnosis, Eastern Cooperative Oncology Group score, stage, treatment regimens, concomitant diseases, drugs used, history of radiotherapy, treatment response of the patients, and treatment toxicity from the database of the haematology department.

Laboratory tests were also carried out to examine the biochemical and metabolic status of patients, including the measurements of complete blood count, kidney, and liver functions.

Finally, Karışmaz and colleagues assessed treatment response using the Lugano response criteria for lymphoma, International Myeloma Working Group Uniform Response Criteria for MM, and International Workshop on Chronic Lymphocytic Leukemia for CLL.

Survival

At the end of follow-up, the probability of overall survival (OS) was slightly lower among patients receiving ≤6 drugs compared with those treated with >6 drugs (36 percent vs 46 percent; p=0.271). [EHA 2023, abstract PB2702]

In the subgroup analysis, the OS probability for MM was 37 percent in patients receiving ≤6 drugs and 97 percent in those receiving >6 drugs at the end of follow-up (p=0.08). Among patients with CLL, the OS probability was 77 percent and 100 percent, respectively (p=0.325). In lymphoma patients, the corresponding rates were 61 percent and 81 percent (p=0.964).

“Multimorbidity, which is generally described as the coexistence of two or more chronic diseases, is usually encountered in the elderly population,” the researchers said. “The therapeutic approach is complicated for patients with more than one chronic condition for both healthcare professionals and patients, leading to unfavourable health outcomes.”

Moreover, managing patients with such comorbidities, particularly those with haematological malignancies and treated with chemo-immunotherapeutic agents, remains a “difficult clinical point,” according to the researchers.

“Polypharmacy in haematological malignancies is also a research area with very little literature data,” they said. “Although the median age of diagnosis of several haematological malignancies such as acute myeloid leukaemia, MM, CLL, and myelodysplastic syndrome is around 70 years, the elderly patients and those with comorbidities are frequently excluded in clinical trials.”

Developing a personalized treatment approach in this population must be considered in the future, the researchers noted.