Consult Pharm. 2014;29(7):434-451.

Multiple Myeloma Treatment and Management in the Elderly.

Johnson TM.

Abstract

More than 60% of Americans with multiple myeloma are older than 65 years of age, and the number of new patients is expected to double by 2030. In addition to this anticipated increase, most patients have advanced disease at diagnosis and require some level of intervention. During the past 10 years, standard care has advanced from chemotherapy and autologous stem-cell transplant to newer targeted agents, introducing the proteasome inhibitors and immunomodulatory agents to the myeloma armamentarium. Myeloma patients live longer because of these novel treatments and better supportive care measures. However, improved disease control comes with new toxicities, and treatment choices need to be balanced with quality of life. Recent clinical trials studied elderly cohorts, and the results can help with geriatric treatment decisions. Expert consensus guidelines and limited trial results in frail individuals provide dose-reduction and monitoring strategies for geriatric practitioners. Ultimately, each patient's physical limitations and vulnerabilities determine optimal myeloma management, and a comprehensive geriatric assessment assists with this aim.