Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population

AbstractPurpose of ReviewApproximately 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 FindingsThe 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 tox icity. 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 m ay be considered in select frail patients with standard-risk MM.SummaryHerein, we review the unique challenges encountered in elderly MM and discuss strategies for optimal management.

Source: Current Hematologic Malignancy Reports - February 28, 2019 Category: Hematology Source Type: research