Latest Advances in the Management of Elderly Patients with Multiple Myeloma

Abstract

431 ISSN 2045-1393 10.2217/IJH.13.58 © 2013 Future Medicine Ltd Int. J. Hematol. Oncol. (2013) 2(6), 431–434 In the last few years many advances have been made in the understanding and treatment of multiple myeloma (MM). MM is a plasma cell neoplasm that accounts for approximately 10% of all hematologic malignancies, it is typical of the elderly, with a median age at diagnosis of 65 years [101]. The diagnosis of MM requires the presence of at least 10% clonal plasma cells on bone marrow examination and/or a biopsy-proven plasmacytoma, as well as evidence of end-organ damage, the socalled ‘CRAB’ symptoms (hypercalcemia, renal insufficiency, anemia or bone lesions) [1]. Although there has been recent discussion about time of treatment, so far no benefit from starting therapy earlier has been evidenced, and thus treatment should be given only when end-organ damage occurs [2]. Patient’s age commonly plays an important role when choosing therapy. The age of 65 years is considered the cutoff for whether a patient is eligible for highdose therapy followed by autologous stem cell transplantation (ASCT). For patients younger than 65 years and with no comorbidities, high-dose therapy and ASCT can be adopted, while for patients older than 65 years, as well as for patients younger than 65 years but with comorbidities, a gentler approach not including ASCT is preferred [2]. However, this strict age cutoff should be considered with caution, since chronological age does not always correspond to biological age. Owing to the increased life expectancy of the general population, the incidence of cancer, including MM, is also rising and physicians have to come to terms with an increasingly hetero geneous patient population. This has inevitably presented new challenges in the therapeutic approach for MM, particularly for older patients. Indeed, aging is associated with reduced organ function and consequently a higher susceptibility to treatment-related adverse events [3]. Therefore, a careful geriatric assessment is suggested and different recently available geriatric scores may be used to appropriately evaluate patients [3,4]. Based on such scores, patients can be classified as very fit, fit and unfit. Unfit patients are characterized by older age, co morbidity, organ dysfunctions