Patient-centered practice in elderly myeloma patients: an overview and consensus from the European Myeloma Network (EMN)

Abstract

Multiple myeloma is a disease typical of the elderly, and, because of the increase in life expectancy of the general population, its incidence is expected to grow in the future. Elderly patients represent a particular challenge due to their marked heterogeneity. Many new and highly effective drugs have been introduced in the last few years and results from clinical trials are promising. Besides the availability of novel agents, a careful evaluation of elderly patients showed to be a key factor for the success of therapy. A geriatric assessment is a valid strategy to better stratify patients. In particular, different scores are available today to appropriately assess elderly patients and define their fitness/frailty status. The choice of treatment-transplantation, triplets, doublets, or reduced-dose therapies including novel agents-should depend on the patient's fitness status (fit, intermediate-fit or frail). Second-generation novel agents have also been evaluated as salvage therapy in the elderly, and these new agents certainly represent a further step forward in the treatment armamentarium for elderly patients with multiple myeloma.

First-line therapy with either bortezomib-melphalan-prednisone or lenalidomide-dexamethasone followed by lenalidomide for transplant-ineligible multiple myeloma patients: a pooled analysis of two randomized trials

“…Patients in the VMP arm of the GIMEMA-MM-03-05 study received nine 6-week induction cycles of intravenous bortezomib at 1.3 mg/m2 on days 1,4,8,11,22,25,29, and 32 during cycles 1 to 4 and on days 1, 8, 22, and 29 during cycles 5 to 9; oral melphalan at 9mg/m2 on days 1 to 4; oral prednisone at 60 mg/m2 on days 1 to 4. The protocol was amended after the inclusion of the first 139 patients, and the schedule was changed to nine 5-week cycles and bortezomib dose was modified to 1.3 mg/m2 on days 1, 8, 15, and 22 during cycles 1 to 9.…”

Determinants of satisfactory patient communication and shared decision making in patients with multiple myeloma

“…Its clinical presentations include anemia, hypercalcemia, impaired renal function, and multiple bone lesions, causing impairment to patients' health and life quality. The incidence of MM is typically associated with increasing age, with 70% of patients being diagnosed at 65 years of age or older . Because of the heterogeneity of the performance status and psychosocial functioning in elderly patients, treatment in MM is especially challenging and requires satisfactory communication between oncologists and other health care providers and patients.…”

Bortezomib consolidation following autologous transplant in younger and older patients with newly diagnosed multiple myeloma in two phase III trials

“…11,17,20,21 Indeed, ASCT is now recommended as a possible treatment option for patients aged up to 75 years who are fit or intermediate-fit. 22 Older patients may well benefit from novel agent-based induction followed by reduced-intensity melphalan conditioning and ASCT, 6,11,22,23 and OS after ASCT has been shown to improve in recent years among patients aged ≥60 years. 19 Our study provided an opportunity to evaluate more closely the circumstances under which older patients benefit from ASCT.…”

“…37 At present, maintenance therapy post-ASCT is widely recommended, whereas consolidation is not as routinely supported. 2,22,[38][39][40][41] Nevertheless, given the heterogeneity of MM, bortezomib-based consolidation therapy may have a role to play in combination with maintenance treatment in specific patient subgroups or treatment settings. Prolonged followup of current studies is warranted.…”

“…Only light chains 39 (22) 36 (20) 23 (23) 19 (18) 16 (21) 17 (22) Durie-Salmon Stage, n (%) IIA 28 (16) 19 (11) 0.5763…”