TY - JOUR
T1 - Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population
AU - Zanwar, Saurabh
AU - Abeykoon, Jithma Prasad
AU - Kapoor, Prashant
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/4/15
Y1 - 2019/4/15
N2 - 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.
AB - 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.
KW - Anti-myeloma therapy
KW - Comorbidities
KW - Frailty
KW - Geriatric assessment
KW - Supportive care
KW - Toxicity
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U2 - 10.1007/s11899-019-00500-4
DO - 10.1007/s11899-019-00500-4
M3 - Review article
C2 - 30820879
AN - SCOPUS:85062621515
SN - 1558-8211
VL - 14
SP - 70
EP - 82
JO - Current Hematologic Malignancy Reports
JF - Current Hematologic Malignancy Reports
IS - 2
ER -