Multiple myeloma (MM) is a disease of aging adults, and numerous therapeutic options are available for this growing demographic. MM treatment of older adults continues to evolve and includes novel combinations, new generations of targeted agents, immunotherapy, and increasing use of autologous stem cell transplantation (ASCT). Understanding age-related factors, independent of chronologic age itself, is an increasingly recognized factor in MM survivorship, especially in understudied populations, such as octogenarians. Octogenarians have inferior survival that cannot be explained by cytogenetic profiles alone. Incorporating assessments of geriatric factors can provide guidance on how to intensify or de-escalate therapeutic options. Functional status, using objective testing, is superior to traditional metrics of performance status and should be implemented to optimize the risk-benefit ratio of ASCT. ASCT is feasible and cost-effective, and chronologic age should not exclude ASCT eligibility. Upfront ASCT remains the standard of care, in the context of a sequential approach that includes pre-transplantation induction and post-transplantation maintenance. High-risk MM is classically defined by disease characteristics, yet shifting frameworks suggest that the high-risk designation could refer to any patient subgroup who is at risk for poorer outcomes-beyond disease-focused outcomes to patient-focused outcomes. Defining the optimal treatment of subgroups of older patients with high-risk disease on the basis of chromosomal abnormalities is unexplored. Here, we review tools to assess individual health status, explore vulnerability in octogenarians with MM, address ASCT decision-making, and examine high-risk MM to understand factors that contribute to survival disparities for older adults with MM.

Approach to the Older Adult With Multiple Myeloma

Mina, Roberto
First
;
Bringhen, Sara;
2019

Abstract

Multiple myeloma (MM) is a disease of aging adults, and numerous therapeutic options are available for this growing demographic. MM treatment of older adults continues to evolve and includes novel combinations, new generations of targeted agents, immunotherapy, and increasing use of autologous stem cell transplantation (ASCT). Understanding age-related factors, independent of chronologic age itself, is an increasingly recognized factor in MM survivorship, especially in understudied populations, such as octogenarians. Octogenarians have inferior survival that cannot be explained by cytogenetic profiles alone. Incorporating assessments of geriatric factors can provide guidance on how to intensify or de-escalate therapeutic options. Functional status, using objective testing, is superior to traditional metrics of performance status and should be implemented to optimize the risk-benefit ratio of ASCT. ASCT is feasible and cost-effective, and chronologic age should not exclude ASCT eligibility. Upfront ASCT remains the standard of care, in the context of a sequential approach that includes pre-transplantation induction and post-transplantation maintenance. High-risk MM is classically defined by disease characteristics, yet shifting frameworks suggest that the high-risk designation could refer to any patient subgroup who is at risk for poorer outcomes-beyond disease-focused outcomes to patient-focused outcomes. Defining the optimal treatment of subgroups of older patients with high-risk disease on the basis of chromosomal abnormalities is unexplored. Here, we review tools to assess individual health status, explore vulnerability in octogenarians with MM, address ASCT decision-making, and examine high-risk MM to understand factors that contribute to survival disparities for older adults with MM.
ASCO 2019 Annual Meeting
Chicago (US)
May 31-June 4
American Society of Clinical Oncology educational book / ASCO.
American Society of Clinical Oncology
39
39
500-518
518
https://ascopubs.org/doi/full/10.1200/EDBK_239067
https://doi.org/10.1200/edbk_239067
Age Factors; Aged; Clinical Decision-Making; Combined Modality Therapy; Disease Management; Female; Genetic Variation; Geriatric Assessment; Humans; Male; Multiple Myeloma; Neoplasm Grading; Neoplasm Staging; Risk Assessment
Mina, Roberto; Bringhen, Sara; Wildes, Tanya M; Zweegman, Sonja; Rosko, Ashley E
File in questo prodotto:
File Dimensione Formato  
[Publisher Version] Mina et al - 2020 - Approach to the older adult - edbk_239067.pdf

Accesso riservato

Descrizione: [Restricted access - Published Version] Mina R et al. Am Soc Clin Oncol Educ Book . 2019 Jan;39:500-518. doi: 10.1200/EDBK_239067. Epub 2019 May 17. © 2019 American Society of Clinical Oncology. All rights reserved. Available at: https://ascopubs.org/doi/full/10.1200/EDBK_239067 | https://doi.org/10.1200/edbk_239067
Tipo di file: PDF EDITORIALE
Dimensione 754.07 kB
Formato Adobe PDF
754.07 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1732782
Citazioni
  • ???jsp.display-item.citation.pmc??? 13
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact