Approach to the Older Adult With Multiple Myeloma

Area of Science:

• Geriatric Hematology
• Oncology
• Clinical Geriatrics

Background:

• Multiple myeloma (MM) predominantly affects aging adults, with evolving treatment strategies including novel agents and autologous stem cell transplantation (ASCT).
• Octogenarians with MM exhibit poorer survival, not solely explained by cytogenetic profiles, highlighting the need to consider age-related factors beyond chronological age.
• Patient-focused outcomes and individualized health assessments are crucial for optimizing MM treatment in older populations.

Purpose of the Study:

• To review tools for assessing individual health status in older adults with MM.
• To explore vulnerability and ASCT decision-making in octogenarians with MM.
• To examine high-risk MM and factors contributing to survival disparities in older adults.

Main Methods:

• Review of geriatric assessment tools and functional status metrics.
• Analysis of ASCT feasibility, cost-effectiveness, and eligibility criteria in older adults.
• Exploration of shifting frameworks for defining high-risk MM beyond disease characteristics.

Main Results:

• Objective functional status assessment is superior to traditional metrics for optimizing ASCT risk-benefit.
• Chronological age alone should not preclude ASCT eligibility; it remains a feasible and cost-effective standard of care.
• Age-related factors and geriatric assessments are critical for guiding treatment intensity and improving MM survivorship.

Conclusions:

• Individualized health status assessment and geriatric factors are essential for optimizing MM treatment and ASCT in older adults, particularly octogenarians.
• Further research is needed to define optimal treatment strategies for subgroups of older patients with high-risk MM based on chromosomal abnormalities.
• A comprehensive approach integrating disease characteristics with patient-focused outcomes is vital for addressing survival disparities in elderly MM patients.