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Updated: Mar 1, 2026
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Myeloma in Elderly Patients: When Less Is More and More Is More
Ashley Rosko1, Sergio Giralt1, Maria-Victoria Mateos1
1From The Ohio State University, Columbus, OH; Memorial Sloan Kettering Cancer Center, New York, NY; University Hospital of Salamanca, Salamanca, Spain; Mayo Clinic, Rochester, MN.
Abstract:
Multiple myeloma is a plasma cell malignancy that occurs among older adults and accounts for 15% of all hematologic malignancies in the United States. Thirty-five percent of patients are diagnosed at age 75 or older. Novel therapeutics and routine use of autologous stem cell transplantation (ASCT) have led to substantial improvements in patient survival, although improvements have been more impressive among patients younger than age 65. Finding the balance between under- and overtreating elderly patients is one of the biggest challenges specific to them as a subgroup of patients with MM. Decision making about which therapies and their dose intensity and duration should be influenced by a patient's functional status, personal preferences, disease characteristics, and ability to tolerate therapy. ASCT should be considered for all patients younger than age 80, assuming that they are not frail. The attainment of a stringent complete response and minimal residual disease negativity is associated with improved progression-free and overall survival. Again, consideration of quality of life for these patients is paramount. Although there is a growing list of tools to sort through these issues, a fully integrated approach has not yet been finely tuned, leaving additional work to be done for the treatment of elderly patients with MM.
Insights
Treating elderly patients with multiple myeloma (MM) requires balancing treatment intensity with patient health. Autologous stem cell transplantation (ASCT) may benefit eligible patients over 65, prioritizing quality of life.
Area of Science:
- Hematology
- Oncology
- Geriatrics
Background:
- Multiple myeloma (MM) is a common plasma cell malignancy in older adults, representing 15% of US hematologic malignancies.
- While novel therapies and autologous stem cell transplantation (ASCT) improve survival, benefits are less pronounced in patients over 65.
- A significant challenge in MM management is balancing undertreatment and overtreatment in elderly patients.
Purpose of the Study:
- To address the complexities of treating elderly patients with multiple myeloma.
- To highlight the importance of personalized treatment decisions considering patient-specific factors.
- To emphasize the role of autologous stem cell transplantation (ASCT) and quality of life in this demographic.
Main Methods:
- Review of current therapeutic strategies for multiple myeloma in older adults.
- Analysis of factors influencing treatment decisions, including functional status, preferences, and disease characteristics.
- Consideration of autologous stem cell transplantation (ASCT) eligibility and outcomes in elderly MM patients.
Main Results:
- Treatment decisions for elderly MM patients must be individualized, considering functional status, comorbidities, and patient preferences.
- Autologous stem cell transplantation (ASCT) should be considered for non-frail patients under 80.
- Achieving stringent complete response and minimal residual disease negativity correlates with improved progression-free and overall survival.
Conclusions:
- Personalized treatment approaches are crucial for optimizing outcomes in elderly multiple myeloma patients.
- Quality of life is a paramount consideration in all treatment decisions for this patient group.
- Further development of integrated approaches is needed for the optimal management of elderly patients with MM.
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