Incorporating novel agents in the management of elderly myeloma patients

In recent years, the treatment of multiple myeloma has undergone significant changes. The availability of novel agents bortezomib, thalidomide and lenalidomide considerably improved the outcome of patients. The advantages related to the use of novel agents have been shown in various studies in patients eligible and ineligible for transplant. In elderly patients, novel agents have also revolutionized the treatment paradigm and have replaced the traditional melphalan-prednisone regimen. A sequential approach consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy, induces a profound cytoreduction and delays relapse, thus improving survival. Patients older than 75 years or who are otherwise vulnerable are more susceptible to adverse events. In this setting, less toxic regimens and appropriate dose-reductions should be adopted. This article provides an overview of the main trials for transplant-ineligible multiple myeloma patients. Recommendations on how to manage unfit patients and treatment-related toxicities are also provided.