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Treatment of Newly Diagnosed Elderly Multiple Myeloma

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Plasma Cell Dyscrasias

Part of the book series: Cancer Treatment and Research ((CTAR,volume 169))

Abstract

Multiple myeloma (MM) is a disease of the elderly, with a median age at diagnosis of approximately 70 years old, and more than 30 % of patients aged >75 years. This latter and very elderly population is going to significantly rise in the near future given the increase in life expectancy in Western countries, and, most importantly, global health status of elderly patients is improving, justifying appropriate treatments. Changes in treatment paradigm from the old melphalan-prednisone regimen used since the 1970s to its use as a backbone in a nontransplant setting since the late 1990s have highlighted different subgroups in elderly MM. Some “elderly” patients could be treated like transplant eligible patients, more likely those aged between 65 and the early 70; while a second group would rather be referred to current approved treatment regimens for the non-transplant setting. A dose-intensity approach seems reasonable for this group, aiming for the best response, eventually the complete response (CR) or even minimal residual disease (MRD). The advent of novel agents such as thalidomide, bortezomib, and most recently lenalidomide have allowed a major improvement in outcome as compared to historical combinations, and soon the novel class of monoclonal antibodies should help to further improve these patients’ survival. Nonetheless, elderly patients are more susceptible to side effects and are often unable to tolerate full drug doses, and thus require lower dose intensity regimens, or novel drugs or combinations with more favourable safety profile. Recent developments in MM have focused on identifying these vulnerable patients through geriatric assessment and novel myeloma scoring system, including the notions of frailty, disability and comorbidities. Eventually, we have reached an era in which we should be able to provide individualized treatment strategies and drug doses—“tailored therapy”—to improve tolerability and optimize efficacy and ultimately survival for most elderly MM patients.

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Authors and Affiliations

  1. Service des maladies du sang, Hôpital Huriez, CHRU, Lille, France

    Guillemette Fouquet, Eileen Boyle & Thierry Facon

  2. Service d’Hématologie et Thérapie Cellulaire, CHU, La Milétrie, Poitiers, France

    Xavier Leleu

  3. Myeloma Unit, Division of Hematology, University of Torino, Turin, Italy

    Francesca Gay, Sara Bringhen, Alessandra Larocca & Antonio Palumbo

Authors
  1. Guillemette Fouquet
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  2. Francesca Gay
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  3. Eileen Boyle
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  4. Sara Bringhen
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  5. Alessandra Larocca
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  6. Thierry Facon
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  7. Xavier Leleu
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  8. Antonio Palumbo
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Correspondence to Xavier Leleu .

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Editors and Affiliations

  1. Dept. of Medical Oncolgy/Hematology,, ASST-Spedali Civili di Brescia Dept. of Medical Oncolgy/Hematology,, Brescia, Brescia, Italy

    Aldo M. Roccaro

  2. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Irene M. Ghobrial

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Fouquet, G. et al. (2016). Treatment of Newly Diagnosed Elderly Multiple Myeloma. In: Roccaro, A., Ghobrial, I. (eds) Plasma Cell Dyscrasias. Cancer Treatment and Research, vol 169. Springer, Cham. https://doi.org/10.1007/978-3-319-40320-5_8

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