New concept of the treatment in elderly patients with multiple myeloma

Abstract

The traditional concept of treatment of patients aged over 65 years with multiple myeloma is historical combination of melphalan and prednisone (MP). The introduction of novel agents, such as immunomodulatory drugs and proteasome inhibitors, has crucially changed the course and prognosis of this disease. The new gold standard of treatment in elderly patients with multiple myeloma is based on synergistic combination of standard MP chemotherapy and novel agents such as thalidomide and bortezomib, as a part of MPT and MVP regimens. Furthermore, promising results have been also obtained with MP plus new generation of immunomodulatory drug lenalidomide. In some patients aged over 65 years and in good general condition, reduced-intensity autologous stem cell transplantation can be an option with application of reduced intensity conditioning regimens and novel agents incorporated into pre-transplant induction treatment and post-transplant consolidation. Certain concern regarding treatment-related adverse events can be overcome by adequate prophylaxis, conscientious follow-up, timely dose-reduction, and application of reduced-intensity MPT and MPV in patients aged over 75 years. The last therapy of choice should be individually tailored according to the clinical profile of the patient and expected toxic effects of planned treatment.