Treatment strategies in elderly patients with multiple myeloma: current status
Hang Quach1, H Miles Prince, Linda Mileshkin
1Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia.
Abstract:
Multiple myeloma (MM), a plasma cell malignancy, is a disorder of the elderly with an increasing prevalence as the average life expectancy increases. Survival remains unacceptably low in elderly patients with MM, in whom the gold standard of treatment has been, until recently, oral melphalan and prednisolone, which induces a response rate of approximately 50% and overall survival of <3 years. In the last 15 years, traditional treatment paradigms for elderly patients with MM have been challenged not only as a result of the change in what we define as 'elderly' but also as a result of the reduced morbidity and treatment-related mortality associated with high-dose chemoradiotherapy (HDT) and autologous stem cell transplantation (ASCT), and the emergence of novel therapies including thalidomide, its immunomodulator drug derivative lenalidomide and the first-in-class proteasome inhibitor, bortezomib. In this review, we examine currently available data regarding the treatment of MM in the elderly population. Recent years have seen a paradigm shift in the standard of care of elderly patients with MM from oral melphalan and prednisolone to approaches including HDT with ASCT using intermediate-dose melphalan in selected elderly patients, and the evaluation of and incorporation of drugs such as thalidomide, bortezomib and lenalidomide. Importantly, we now have been able to change the traditional goal of palliation in the elderly group of patients to a more ambitious objective of achieving a complete response or a near complete response, in the hope that this will translate into improved progression-free survival, overall survival and quality of life.
Insights
Elderly patients with multiple myeloma (MM) now have improved treatment options beyond oral melphalan and prednisolone. Novel therapies and high-dose chemotherapy with autologous stem cell transplantation offer better response rates and survival.
Area of Science:
- Hematology
- Oncology
- Geriatric Medicine
Background:
- Multiple myeloma (MM) is a plasma cell malignancy predominantly affecting the elderly, with historically poor survival rates.
- Traditional treatment with oral melphalan and prednisolone offers limited efficacy, with response rates around 50% and survival under 3 years.
- Increasing life expectancy leads to a growing prevalence of MM in older populations, necessitating updated treatment strategies.
Purpose of the Study:
- To review current treatment data for elderly patients with multiple myeloma (MM).
- To examine the paradigm shift in MM treatment for the elderly population.
- To evaluate the impact of novel therapies and high-dose chemotherapy on MM outcomes in older adults.
Main Methods:
- Review of currently available data on MM treatment in the elderly.
- Analysis of treatment paradigms including high-dose chemoradiotherapy (HDT) and autologous stem cell transplantation (ASCT).
- Evaluation of novel therapies such as thalidomide, lenalidomide, and bortezomib in elderly MM patients.
Main Results:
- Recent years show a shift from oral melphalan and prednisolone to more intensive approaches for elderly MM patients.
- High-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT) is being used in selected elderly patients.
- Novel agents like thalidomide, bortezomib, and lenalidomide are being incorporated into treatment regimens.
Conclusions:
- The standard of care for elderly MM patients has evolved significantly, moving beyond palliative approaches.
- Intensified treatment strategies, including HDT-ASCT and novel therapies, aim for complete or near-complete responses.
- The goal is to improve progression-free survival, overall survival, and quality of life in elderly MM patients.
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