Determining treatment intensity in elderly patients with multiple myeloma

ABSTRACT

Introduction: In the majority of cases, multiple myeloma is a disease occurring in elderly patients. In the last decades, a major improvement in myeloma patients’ outcome has been achieved with the introduction of several new drugs. However, this positive outcome was less likely to occur in elderly patients.

Areas covered: An overall increase of myeloma cases in elderly patients is expected in the next years. This patient population is highly heterogeneous in terms of physiological functions and ability to resist stressing conditions such as myeloma and its treatment. While physicians cannot prevent the stress arising from the disease itself, the intensity of therapeutic approaches can be tuned according to patients’ predicted tolerance. In this review, we focus on the assessment of patients’ fitness and on available significant data on treatment efficacy and tolerability in elderly patients.

Expert commentary: Fit, elderly patients should undergo full-dose therapy to maximize the depth of response, while intermediate and frail patients benefit from reduced-dose regimens in order to avoid toxicity and preserve quality of life. Ongoing trials will provide further evidence to individualize treatment on the basis of geriatric assessment and disease characteristics.

KEYWORDS:

• Multiple myeloma (MM)
• novel agents
• frailty
• geriatric assessment
• tailored therapy

Declaration of interest

S Bringhen declares receiving honoraria from Bristol Myers Squibb, Celgene, Amgen, and Janssen; has sat on the advisory boards for Amgen and Janssen; and has acted as a consultant for Takeda. M Boccadoro has received honoraria from Sanofi, Celgene, Amgen, Janssen, Novartis, AbbVie, and Bristol Myers Squibb and has received research funding from Celgene, Janssen, Amgen, Bristol Myers Squibb, Mundipharma, Novartis, and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.