Management of older adults with multiple myeloma

Abstract

Two-thirds of patients with multiple myeloma are aged 65 years or more and the prevalence of multiple myeloma in elderly patients is expected to rise in the next future. Patients older than 65 years are usually considered ineligible for transplantation. The introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, combined with conventional chemotherapy, has radically changed the treatment paradigm of elderly patients and improved outcome. A sequential approach, consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy, induces a profound cytoreduction and delays relapse, thus improving survival. Novel agents associated with reduced-intensity autologous transplant showed to be safe and effective in fit elderly patients. Patients older than 75 years or vulnerable ones are more susceptible to adverse events that negatively affect treatment adherence and outcome. In this setting, less toxic regimens and appropriate dose reductions should be adopted. Here we provide an overview of novel agent-based treatment strategies for elderly patients with multiple myeloma.

Once-Weekly 1.6 mg/m2 Bortezomib BCD Regimen in Elderly Patients with Newly Diagnosed Multiple Myeloma Who are Unfit for Standard Dose Chemotherapy

“…The depth of response and its duration are important prognostic factors in MM. Attaining a CR proved to be an independent predictor of longer survival in elderly patients treated with both conventional chemotherapy and novel agents [28,29]. Our study also confirms this conclusion.…”

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

“…• Bortezomib, melphalan and prednisolone (VMP) (75,80) ( Table 15) • Bortezomib, cyclophosphamide and dexamethasone (VCD) (47,48) (Table 16) • Bortezomib and dexamethasone (VD) (82) (Table 17) • Cyclophosphamide, thalidomide and dexamethasone attenuated (CTDa) (54) (Table 18) • Melphalan, prednisolone and thalidomide (MPT) (83) (Table 19) • Thalidomide and dexamethasone (TD) (84) (Table 20) • Bortezomib, lenalidomide and dexamethasone (VRD) ( Table 9) (77) • Lenalidomide and dexamethasone (RD) (76) (Table 21) Dose adjustment guidelines, depending on patient fi tness, are summarised in Table 22. (85) …”

Developments in the Field of Myeloma in the Last Decade

“…IMWG has developed a geriatric assessment tool that predicts the risks of serious morbidity and mortality of proposed treatment (Table 2). While managing elderly myeloma patients, these factors must be assessed prior to institution of anti-myeloma drugs [11]. The patients and the families must be explained every aspect and allow them to decide when more than one option is available.…”