Optimal management of elderly patients with myeloma

Abstract

Many advances have been made in the treatment of patients with multiple myeloma including elderly subjects. The introduction of novel agents, such as thalidomide, lenalidomide, bortezomib, have revolutionized the treatment paradigm of this neoplasm, and second-generation molecules are currently being tested to offer patients a wider variety of treatment options and to improve outcome. The efficacy of a regimen should be carefully balanced against its toxicity profile. Elderly patients are particularly susceptible to adverse events that may lead to early treatment discontinuation. Thus, a more accurate distinction within the elderly population and a more appropriate treatment allocation is necessary. Here we describe the major and more recent treatment options available today for elderly patients with multiple myeloma.

Keywords::

• diagnosis
• elderly
• multiple myeloma
• novel agents
• relapse

Financial & competing interests disclosure

A Palumbo has received honoraria and consultancy fees from Amgen, Bristol-Myers Squibb, Celgene, Janssen, Millenium, Onyx. 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.

The authors would like to thank Giorgio Schirripa for editorial assistance.

Key issues

• Novel agents such as the immunomodulatory drugs thalidomide and lenalidomide, and the proteasome inhibitor bortezomib have revolutionized the treatment of elderly patients with multiple myeloma.

• Elderly patients with multiple myeloma are usually not considered eligible for high-dose melphalan and transplantation.

• A careful assessment of patient's conditions and status is needed to choose the best and more appropriate strategy.

• Very fit patients may undergo reduced-dose intensity autologous stem cell transplantation; in these patients, a sequential approach with novel agents and transplantation may be of benefit.

• Fit patients can be safely treated with full-dose regimens.

• Reduced-dose regimens or two-drug regimens should be preferred for unfit patients.

• Therapy at relapse should be based on type of previous therapy, depth and duration of response to previous therapy.

Notes