Myeloma in the elderly P040 POLYPHARMACY AND POTENTIALLY INAPPROPRIATE MEDICATION IN ELDERLY PATIENTS TREATED FOR MULTIPLE MYELOMA

Introduction: Potentially Inappropriate Medications (PIM) can increase adverse drug events incidence. Elderly patients are particularly at risk because of several comorbidities requiring pharmacotherapy. The prevalence of polypharmacy in older adults ranges from13% to 92%, depending on the polypharmacy definition and on the study population characteristics. Cancer related therapy adds to this risk in older adults, but few studies have been conducted in this population. In multiple myeloma, renal insufficiency is frequent and increase adverse events risk. In patients with therapeutic indication, the overall 5-year survival has increased significantly with new targeted therapies also in the elderly. When patients are ineligible for transplantation, the standard treatment is a combination therapy based with melphalan, corticosteroid plus bortezomib (VMP) or thalidomide (MPT). Toxicities are common (30-40% of cases in early treatment). Objectives: The aim of this study is to evaluate polypharmacy and PIM prevalences in elderly people treated for multiple myeloma. Methods: Retrospective study from January 1st to December 31st 2013 in the hematology unit of Caen University Hospital. Including consecutive patients ≥70 years for whom a treatment has been introduced for multiple myeloma (oral or parenteral treatment in daily hospitalization). Polypharmacy (≥5 daily different medications before introducing chemotherapy), PIM (Independent and Considering Diagnosis Medications to avoid in 2012 version Beers list), renal insufficiency, comorbidity (Charlson Comorbidity Index) were collected. Univariate analysis was performed with Anova test, correlation with Pearson, Spearman. Results: 96 patients were included: mean age was 77,7 years [70– 92], median age 76,5, with no difference inside sex subgroup, 34 were 80 years old and over, 48 female. Renal function was normal in only 12% of patients with MDRD formula, and 9% with Cockroft (missing data for 8 patients). 36% had serum albumin b30 g/l (10 missing data) 74% had polymedication whereas mean CCI was only 1,1 (62% had CCI ≤ 1) Mean PIM per patient was 1,17 with Beers list [0–6], only 37,5% had no PIM. Each patient had at least one of these fragility. Polymedication and number of PIM were significatively correlated (p b0.001 bilateral, Chi). CCI ≥ 1 was significatively correlated with male sexe (p = 0.037 bilateral, Chi). There was no link between CCI and polymedication, nor age. Conclusion: High rate of polypharmacy, PIM and renal insufficiency in the elderly with multiple myeloma, requires combined pharmaceutical and geriatric assessments, with patients and general practitioners education, before introducing chemotherapy. That may leads to further adverse events. Both evaluation will be included in a daily oncogeriatric hospitalization. References: Ronald J. Maggiore, Cary P. Gross and Arti Hurria.Polypharmacy in Older Adults with Cancer The Oncologist 2010, 15:507–522.doi: 10.1634/theoncologist.2009-0290 originally published online April 24, 2010 Palumbo A, Mina R. Management of older adults with multiple myeloma. Blood Rev. 2013 May;27(3):133–42. doi: 10.1016/ j.blre.2013.04.001. Epub 2013 Apr 25. Review. Engelhardt M et al. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma HAemtologica 2014 Feb; 99(2):232–42 Disclosure of Interest: None declared