Special considerations for the treatment of multiple myeloma according to advanced age, comorbidities, frailty and organ dysfunction

Abstract

Multiple Myeloma (MM) is primarily a disease of old age with a median age of sixty-nine years at diagnosis. The development of novel therapies for induction and use of autologous stem cell transplantation has resulted in improved clinical outcomes and better quality of life for MM patients. Elderly patients, comprising the majority of MM population, have a higher incidence of age-related comorbidities, frailty and organ dysfunction which complicates the coordination of treatment and limits the selection of therapies. Even in the era of multiple chemotherapeutic options, the clinical heterogeneity of the myeloma patients' demands personalized treatments which often require dose-adjustments or dose delays. The use of reduced-dose regimens and various comorbidity indices has improved clinical outcome and regimen tolerability in MM patients with renal, neurological and bone abnormalities. We focus on advancements in the treatment of multiple myeloma with the goal to guide clinicians towards patient-specific management.

Longer term outcomes with single‐agent belantamab mafodotin in patients with relapsed or refractory multiple myeloma: 13‐month follow‐up from the pivotal DREAMM‐2 study

“… 6 , 7 Renal impairment is also highly prevalent in the elderly (the age group with the highest prevalence of RRMM) and is associated with poorer RRMM outcomes. 8 , 9 , 10 , 11 At baseline and relapse, patients with RRMM may present with extramedullary disease (EMD), characterized by the presence of malignant plasma cells outside the bone marrow; this again confers a poor prognosis. 12 There are currently no guidelines on the treatment of patients with EMD.…”

Medication Adherence Among Adults With Comorbid Chronic Conditions Initiating Oral Anticancer Agent Therapy for Multiple Myeloma

“…[23][24][25] The current study further confirms this need in a cancer population at high risk of chronic disease complications when the cancer treatment or cancer itself has a propensity for worsening the control of the chronic disease as is the case in MM. 26,27 In addition, it is known that the increasing presence of comorbidities in a patient with MM is associated with a decrease in survival. 28 Given this information and the above findings related to alarmingly low adherence rates, the importance of enhanced interdisciplinary and coordinated care in this high-risk patient population should be emphasized.…”

Cystatin C-Based Equations Detect Hidden Kidney Disease and Poor Prognosis in Newly Diagnosed Patients with Multiple Myeloma

“…Renal function is usually estimated using sCr using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-based equation in order to estimate glomerular filtration rate (eGFR). Nevertheless, international guidelines recognize that equations based on sCr are imprecise and they do not represent the most accurate method for evaluating RI, especially in elderly patients owning malnutrition and fragility, very common characteristics of patients with MM [ 10 ]. In this context, the Kidney Disease Improving Global Outcomes (KDIGO) recommends equations based on the combination of sCr and cystatin C (CysC) (CKD-EPI-sCr-CysC) to estimate GFR for chronic kidney disease or RI in patients under treatment using drugs with narrow therapeutic range [ 11 ].…”