How I treat elderly patients with myeloma

Abstract

The clinical approach to older patients with myeloma has to be modified to take into account comorbidities and the likelihood of higher treatment-related toxicity. Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects. Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently. The sequential use of active agents singly and in different combinations has improved response rates and survival of all patients with myeloma, including the elderly. (Blood. 2010;116(13):2215-2223)

European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma

“…15,73 For patients with recurrent, severe bacterial infections, intravenous immune globulin can be effective. 65 Peripheral neuropathy (PNP) is an important toxicity of both thalidomide and bortezomib occurring in approximately 50% of patients. 74 PNP from thalidomide is cumulative, dose dependent and usually permanent.…”

Autologous stem cell transplantation in elderly patients with multiple myeloma: evaluation of its safety and efficacy

“…When compared with matched-pair patients treated with melphalan and prednison (MP), the efficacy of ASCT was significantly superior to MP in terms of complete response (CR) rate, event-free survival (EFS) and OS, without transplant-related deaths. Based on these reports, elderly patients with MM in otherwise fit medical condition have been considered to be eligible for ASCT irrespective of the chronological age in many institutions [21,22]. Accordingly, several single institution studies have reported their experience of ASCT in elderly patients [23][24][25][26][27][28][29][30].…”

A third-generation IMiD for MM

“…3 Disruption of HSC quiescence prematurely exhausts the HSC pool and causes hematologic failure under various stresses, such as oxidative, replicative, and metabolic, and DNA damage. 4 HSCs are exposed to various ROS, which are routinely generated during metabolic or inflammatory process (reviewed in Naka and Hirao 5 ). ROS induce a variety of responses in HSCs, including cellular proliferation and apoptosis.…”

“…Indeed, mice with mutations in several oxidative stress response (Atm, Fancc, Fancd2, FoxO) and DNA damage repair (Lig4, Dna-pk, Ku80, Xpd, mTR) genes exhibit premature exhaustion of HSCs because of accumulation of ROS or DNA damage. 4,5,7 Less is known about how oxidative DNA damage affects the function and lifespan of human HSCs. Yahata and colleagues use a…”

“…2 Novel agents, initially approved for the treatment of relapsed or refractory (rel/refr) MM, are actually used up-front as part of induction therapy for both transplant-and nontransplant-eligible patients, and studies are under way to evaluate their role in additional therapeutic phases, such as consolidation and maintenance. 3,4 However, almost all patients treated with these new classes of agents inevitably develop drug resistance over time, and ultimately relapse. Mechanisms leading to resistance are largely unknown.…”