Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population

Saurabh Zanwar, Jithma Prasad Abeykoon, Prashant Kapoor

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Purpose of Review: Approximately one half of the patient-population in multiple myeloma (MM) is > 70 years at diagnosis. Despite notable strides in the management and improved survival, MM remains incurable, with an increasing proportion of elderly patients comprising the relapsed-refractory cohort. Recent Findings: The arbitrary age cutoff at 65 years to define the elderly patient-population has evolved to a more nuanced categorization, incorporating a comprehensive assessment for determining frailty prior to commencing treatment. This step is critical in determining the therapy-intensity, including transplant-eligibility, to minimize toxicity. Dose-modifications are crucial, as the merits of continuous therapy are becoming evident in this patient-population. Bortezomib, lenalidomide, and dexamethasone (VRd) combination has emerged as standard of care for newly diagnosed MM. Fixed-duration Rd followed by reduced-dosed continuous R may be considered in select frail patients with standard-risk MM. Summary: Herein, we review the unique challenges encountered in elderly MM and discuss strategies for optimal management.

Original languageEnglish (US)
Pages (from-to)70-82
Number of pages13
JournalCurrent Hematologic Malignancy Reports
Volume14
Issue number2
DOIs
StatePublished - Apr 15 2019

Keywords

  • Anti-myeloma therapy
  • Comorbidities
  • Frailty
  • Geriatric assessment
  • Supportive care
  • Toxicity

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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