Multiple myeloma in the very elderly patient: challenges and solutions

Abstract

Diagnosis and management of myeloma in the very elderly patient is challenging. Treatment options have vastly improved for elderly myeloma patients but still require the clinician to personalize therapy. In this paper, we offer evidence-based, pragmatic advice on how to overcome six of the main challenges likely to arise: 1) diagnosis of myeloma in this age group, 2) assessment of the need for treatment, and the fitness for combination chemotherapy, 3) provision of the best quality of supportive care, 4) choice of combination chemotherapy in those fit enough for it, 5) treatment of relapsed myeloma, and 6) provision of end of life care. With an increased burden of comorbidities and a reduced resilience to treatment and its associated toxicities, the management of myeloma in this age group requires a different approach to that in younger patients to maximize both quality and length of life.

Keywords:

• myeloma
• elderly
• diagnosis
• treatment

Acknowledgments

TE is funded by the Julian Starmer-Smith research fund and has received honorarium from Takeda. AK is funded by Wellcome Trust. KR is supported by the NIHR Biomedical Research Centre (Oxford). The views expressed are those of the authors and not necessarily those of the Department of Health.

Author contributions

TE, JW, AK, CW, and FB wrote the manuscript. TE produced Table 3 and Figure 1. CW produced Figure 2. KR, TE, JW, and AK edited the manuscript. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work. All authors critically reviewed the manuscript and agreed on the final version.

Disclosure

TE has received consultancy honoraria from Janssen. KR has received honoraria from Jansenn, Celgene, Takeda and Amgen. The authors report no other conflicts of interest in this work.