How I treat fragile myeloma patients
Alessandra Larocca1, Antonio Palumbo1
1Myeloma Unit, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
Abstract:
Multiple myeloma is a disease typical of elderly people, with a median age at diagnosis of 70 years. Much progress has been made in the past few years thanks to the introduction of new drugs. However, increases in survival were much less pronounced in patients aged 60 to 69 years, and no improvement was seen in older patients. Furthermore, the currently approved treatment regimens were tested in clinical trials with stringent inclusion criteria. Aging is associated with a high prevalence of frailty, that is, a state of increased vulnerability to stressors due to a critical decline in physiologic reserves. Elderly people may be categorized as fit or frail according to clinical, functional, cognitive, and socioeconomic criteria. The presence of frailty may complicate the management and outcome of myeloma patients. To date, the choice of treatment of myeloma patients has focused primarily on chronological age and performance status as markers of frailty. However, the elderly population is highly heterogeneous, and improved assessment strategies are needed to define the frailty profile of patients and provide them with the most adequate treatment, thus avoiding the overtreatment of frail patients and the undertreatment of fit patients. The geriatric assessment is a fundamental tool for the evaluation of cognitive and functional status.
Insights
Elderly patients with multiple myeloma show varied responses to new treatments. A comprehensive geriatric assessment is crucial for tailoring therapy to individual frailty levels, improving outcomes for older adults.
Area of Science:
- Geriatric Medicine
- Hematology
- Oncology
Background:
- Multiple myeloma predominantly affects the elderly, with a median diagnosis age of 70.
- Recent therapeutic advancements have improved survival, but benefits are less pronounced in older age groups.
- Current treatment guidelines often overlook the heterogeneity of aging and frailty in elderly patients.
Observation:
- Aging is linked to frailty, a state of vulnerability due to declining physiological reserves.
- Elderly individuals can be classified as fit or frail based on clinical, functional, cognitive, and socioeconomic factors.
- Frailty significantly impacts the management and prognosis of multiple myeloma patients.
Findings:
- Chronological age and performance status are insufficient markers for assessing frailty in myeloma patients.
- The elderly population is heterogeneous, necessitating improved assessment strategies beyond traditional metrics.
- Geriatric assessment is vital for evaluating cognitive and functional status to guide treatment decisions.
Implications:
- Accurate frailty assessment can prevent overtreatment of frail patients and undertreatment of fit patients.
- Personalized treatment strategies based on comprehensive geriatric assessment are needed for elderly myeloma patients.
- Integrating geriatric assessment into clinical practice can optimize care and outcomes for older adults with multiple myeloma.
More Related Videos
09:41An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
10:04Establishment of a Human Multiple Myeloma Xenograft Model in the Chicken to Study Tumor Growth, Invasion and Angiogenesis
Published on: May 1, 2015
Related Concept Videos
02:56Treatment Resistant Cancers
02:57Targeted Cancer Therapies
There are several types of targeted therapies against...
02:56Treatment Resistent Cancers
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
01:20Myasthenia Gravis: Overview and Treatment
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...