The characteristics, treatment patterns, and outcomes of older adults aged 80 and over with multiple myeloma

Fiala, Mark A.; Foley, Nicole; Vij, Ravi; Wildes, Tanya M.

doi:10.1016/j.jgo.2020.03.005

Cited by 13 publications

(14 citation statements)

References 23 publications

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“…PFS and OS were significantly shorter in the ≥85-year group versus the younger-age groups; this is expected and consistent with previous reports, as life expectancy is a key factor in OS [ 4 , 6 ,]. Of note, TTP was significantly shorter in the ≥85-year versus the <65-year group, but was similar versus each of the other two age groups, supporting previous data on the potential benefit of active treatment of elderly patients with NDMM [ 11 ]. TTP was included as an endpoint in this study, given the competing risk of death, particularly in elderly patients, which was censored in the TTP analysis.…”

supporting

confidence: 82%

Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect® MM Registry

et al. 2021

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supporting

confidence: 82%

Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect® MM Registry

et al. 2021

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“…Nevertheless, among octogenarian MM patients receiving treatment, the benefit was similar to that observed in younger patients (70-79 years old). The median OS of octogenarian MM patients receiving treatment vs. those referred to supportive care is 21.4 months vs. 6 months [78]. When looking at goals of therapy in these delicate patients, we need to consider tolerability and, consequently, quality of life during treatment as key factors.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients

Bonello

Boccadoro

Larocca

2020

Cancers

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Multiple myeloma (MM) mostly affects elderly patients, which represent a highly heterogeneous population. Indeed, comorbidities, frailty status and functional reserve may vary considerably among patients with similar chronological age. For this reason, the choice of treatment goals and intensity is particularly challenging in elderly patients, and it requires a multidimensional evaluation of the patients and the disease. In recent years, different tools to detect patient frailty have been developed, and the International Myeloma Working Group frailty score currently represents the gold standard. It identifies intermediate-fit and frail patients requiring gentler treatment approaches compared to fit patients, aiming to preserve quality of life and prevent toxicities. This subset of patients is underrepresented in clinical trials, and studies exploring frailty-adapted approaches are scarce, making the choice of therapy extremely challenging. Treatment options for intermediate-fit and frail patients might include dose-adapted combinations, doublets, and less toxic combinations based on novel agents. This review analyzes the available tools for the assessment of frailty and possible strategies to improve the discriminative power of the scores and expand their use in real-life and clinical trial settings. Moreover, it addresses the main therapeutic challenges in the management of intermediate-fit and frail MM patients at diagnosis and at relapse.

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“…44,45 Only half of patients over age 80 received any antimyeloma therapy in one study. 46 Reasons for nontreatment are unexplored in the literature, but presumably center on concerns about toxicity. Conversely, some older patients may experience increased risk of toxicity with aggressive therapy.…”

Section: Tightrope Of Treatment: Avoiding Undertreatment and Overtreatment In Older Adultsmentioning

confidence: 99%

Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies

Wildes¹,

Artz

2021

American Society of Clinical Oncology Educational Book

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With the aging of the population, the number of older adults with hematologic malignancies is growing, and treatment paradigms for these patients are rapidly evolving. Use of allogeneic stem cell transplant has been expanding to include septuagenarians but remains a potentially morbid procedure, creating an opportunity for a geriatric-focused evaluation to improve assessment of the individual’s risk in undergoing the procedure. Although age alone should not be the sole determinant for transplant eligibility, geriatric assessment often identifies vulnerabilities that are not captured in assessing performance status and comorbidities alone. Those vulnerabilities may be optimized in an approach employing three sequential steps: characterize resiliency, bolster resilience, and harmonize with patient goals. Data are emerging that show that this approach is associated with lower nonrelapse mortality, shorter length of stay, and better survival after transplant. In older adults with myeloma, treatment recommendations also aim to balance the expected efficacy and toxicity profile and incorporate the patient’s goals and preferences. Assessment of frailty allows for more personalized estimates of risk of toxicity. Currently, the European Myeloma Network currently recommends using the International Myeloma Working Group frailty scale as a standard approach to defining frail or at-risk populations with myeloma. In addition to treatment selection, the care of older adults with myeloma must include consideration of other issues, including reducing early mortality with antibiotic prophylaxis, polypharmacy, depression, cognition, and falls. Overall, appreciation of the aging-associated vulnerabilities will allow for the ultimate personalized care and treatment of older adults with hematologic malignancies.

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The characteristics, treatment patterns, and outcomes of older adults aged 80 and over with multiple myeloma

Cited by 13 publications

References 23 publications

Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect® MM Registry

Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect® MM Registry

Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients

Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies

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