Introduction: In the majority of cases, multiple myeloma is a disease occurring in elderly patients. In the last decades, a major improvement in myeloma patients’ outcome has been achieved with the introduction of several new drugs. However, this positive outcome was less likely to occur in elderly patients. Areas covered: An overall increase of myeloma cases in elderly patients is expected in the next years. This patient population is highly heterogeneous in terms of physiological functions and ability to resist stressing conditions such as myeloma and its treatment. While physicians cannot prevent the stress arising from the disease itself, the intensity of therapeutic approaches can be tuned according to patients’ predicted tolerance. In this review, we focus on the assessment of patients’ fitness and on available significant data on treatment efficacy and tolerability in elderly patients. Expert commentary: Fit, elderly patients should undergo full-dose therapy to maximize the depth of response, while intermediate and frail patients benefit from reduced-dose regimens in order to avoid toxicity and preserve quality of life. Ongoing trials will provide further evidence to individualize treatment on the basis of geriatric assessment and disease characteristics.

Determining treatment intensity in elderly patients with multiple myeloma

Salvini M.
Co-first
;
D'Agostino M.
Co-first
;
Bonello F.;Boccadoro M.;Bringhen S.
Last
2018

Abstract

Introduction: In the majority of cases, multiple myeloma is a disease occurring in elderly patients. In the last decades, a major improvement in myeloma patients’ outcome has been achieved with the introduction of several new drugs. However, this positive outcome was less likely to occur in elderly patients. Areas covered: An overall increase of myeloma cases in elderly patients is expected in the next years. This patient population is highly heterogeneous in terms of physiological functions and ability to resist stressing conditions such as myeloma and its treatment. While physicians cannot prevent the stress arising from the disease itself, the intensity of therapeutic approaches can be tuned according to patients’ predicted tolerance. In this review, we focus on the assessment of patients’ fitness and on available significant data on treatment efficacy and tolerability in elderly patients. Expert commentary: Fit, elderly patients should undergo full-dose therapy to maximize the depth of response, while intermediate and frail patients benefit from reduced-dose regimens in order to avoid toxicity and preserve quality of life. Ongoing trials will provide further evidence to individualize treatment on the basis of geriatric assessment and disease characteristics.
18
9
917
930
https://www.tandfonline.com/doi/abs/10.1080/14737140.2018.1496823?journalCode=iery20
https://doi.org/10.1080/14737140.2018.1496823
frailty; geriatric assessment; Multiple myeloma (MM); novel agents; tailored therapy; Age Factors; Aged; Antineoplastic Agents; Dose-Response Relationship, Drug; Geriatric Assessment; Humans; Multiple Myeloma; Quality of Life; Treatment Outcome; Physical Fitness
Salvini M.; D'Agostino M.; Bonello F.; Boccadoro M.; Bringhen S.
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Descrizione: [Restricted access - Author vsn.] Salvini M, D'Agostino M, et al. Expert Rev Anticancer Ther. 2018 Sep;18(9):917-930. doi: 10.1080/14737140.2018.1496823. Epub 2018 Jul 13. © 2018 Informa UK Limited, trading as Taylor & Francis Group. The published version is available at: https://www.tandfonline.com/doi/abs/10.1080/14737140.2018.1496823?journalCode=iery20 | https://doi.org/10.1080/14737140.2018.1496823
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1790866
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