First-Line Bortezomib Associated With Increased Risk of Falls for Geriatric Multiple Myeloma

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

Elderly patients with multiple myeloma who were treated with first-line bortezomib had a higher risk of falls vs age-matched controls.

Bortezomib as a first-line treatment for older adults with multiple myeloma was associated with a higher risk of falls, with a decrease in overall survival (OS) noted among those who fell within a year of starting treatment, according to a study published in the Journal of Geriatric Oncology.

Diagnostic codes for falls were reported in 157 patients within 12 months of starting treatment with bortezomib vs 102 who did not receive treatment with the agent (P <.001). After controlling for covariates, investigators reported that bortezomib was associated with a 36% increased risk of falls (aHR, 1.36; 95% CI, 1.05-1.75; P = .018).

“While patients with multiple myeloma are more likely to fall compared with age-matched controls, the relationship between falls in older adults with multiple myeloma and specific myeloma-directed therapies has not been previously well-elucidated. Bortezomib, with its risk of treatment-related peripheral neuropathy, is of particular concern as a potential contributor to falls in this patient population,” the investigators wrote.

A total of 4084 older patients were eligible for the analysis, 271 of whom had a diagnostic code for falls within 12 months of treatment initiation. The median time to fall was 129 days (Interquartile range [IQR], 62-215). During pre- and post-treatment, patients had similar rates of falls, with 8% of patients having a diagnostic code for falls during both periods.

As first-line therapy, bortezomib was used in 2052 patients. Patients taking bortezomib were more likely to have a diagnostic code for peripheral neuropathy within 12 months of starting treatment (27.7%) compared with those who did not receive treatment (14.8%; P <.001); patients with peripheral neuropathy were more likely to fall than those who did not (8.0% vs 5.9%; P = .020).

Bortezomib was associated with an increased risk of falls in the bivariate analysis (29%; HR, 1.29; 95% CI, 1.00-1.65; P = .047) and multivariate analysis (36%) after controlling for factors such as age, gender, race, and comorbidities and poor performance status. When stratifying by age, investigators identified that the association is potentially stronger among patients younger than 75 years (aHR, 1.65; 95% CI, 1.05-2.59; P = .029) compared with older patients (aHR, 1.26; 95% CI, 0.93-1.72; P = .140).

Additional factors associated with an increased risk of falls were advanced age (aHR, 1.06 per year; 95% CI, 1.04-1.08; P <.001), history of falls (aHR, 2.00; 95% CI, 1.39-2.88; P <.001), depression (aHR, 1.48; 95% CI, 1.09-2.01; P = .012), and polypharmacy (aHR, 1.37; 95% CI, 1.04-1.80; P = .024).

The sensitivity analysis found that among 2967 patients who survived following 12 months after starting treatment, bortezomib was associated with a 58% increased risk of falls (aOR, 1.58; 95% CI, 1.15-2.17; P = .005).

The median OS for patients who fell was 35.7 months (95% CI, 29.1-48.4) vs 49.1 months (95% CI, 47.1-52.8) for those who did not (P <.0001).

Reference

Schoenbeck KL, Fiala MA, Wildes TM. Bortezomib in first-line therapy is associated with falls in older adults with multiple myeloma. J Geriatr Oncol. 2021;12(7):1005-1009. doi:10.1016/j.jgo.2021.02.009