Assessment and treatment options for transplant-ineligible patients with multiple myeloma

Abstract

At diagnosis, approximately 40% of patients with multiple myeloma are older than 75 years. Thus, treatments for multiple myeloma should take into consideration the following factors: 1) disease-related factors, such as chromosomal abnormalities and speed of progression; 2) therapy-related factors, such as drug resistance and toxicity; and 3) patient-specific factors, such as age, organ dysfunction, and availability of family support. Moreover, with the development of novel therapeutic agents, including antibodies, overcoming the high risk of disease-related factors, even in older patients, is becoming possible by attaining favorable responses to treatment. However, the premise is to continue highly effective treatments from an early stage and maximize the performance of the selected treatments. Therefore, treatments must be provided regularly while adjusting its intensity and duration. Furthermore, for older patients with high frailty, improving and maintaining the health-related quality of life may be necessary. Hence, various treatments and frailty assessments here are described here, including therapeutic ingenuity and supportive care strategies for developing individualized treatments for transplant-ineligible patients.