How I treat multiple myeloma in geriatric patients
Thierry Facon1, Xavier Leleu2, Salomon Manier1
1Department of Hematology, University of Lille, Centre Hospitalier Universitaire Lille, Lille, France.
Abstract:
Multiple myeloma (MM) is primarily a disease of older patients. Until recently, geriatric aspects in the context of MM have been poorly investigated. Treatment outcomes for geriatric patients with MM are often compromised by comorbidities and an enhanced susceptibility to adverse events from therapy. Assessment of patient frailty has become more frequent and will be useful in the context of significant and continuous advances in therapy. The recent emergence of immunotherapy with CD38 monoclonal antibodies and upcoming immunooncology drugs, such as bispecific antibodies, will lead to additional therapeutic progress. The applicability of these new molecules to older and frail patients is a key clinical question. Here, we present 2 patient cases derived from clinical practice. We review current frailty scores and standards of care for older, newly diagnosed patients with MM, including frail subgroups, and discuss ways to tailor treatment, as well as treatment perspectives in this population.
Insights
Geriatric patients with multiple myeloma (MM) face unique challenges due to comorbidities and treatment side effects. Tailoring new immunotherapies like CD38 antibodies for older and frail MM patients is crucial for better outcomes.
Area of Science:
- Hematology
- Geriatric Medicine
- Oncology
Background:
- Multiple myeloma (MM) predominantly affects older adults, yet geriatric considerations have been historically under-researched.
- Treatment outcomes in elderly MM patients are often hindered by comorbidities and increased susceptibility to adverse events.
- Assessing patient frailty is increasingly important given rapid therapeutic advancements.
Approach:
- Presents two clinical case studies of geriatric patients with newly diagnosed MM.
- Reviews current frailty assessment tools and standard care guidelines for older MM patients.
- Discusses strategies for personalized treatment and future therapeutic perspectives for this population.
Key Points:
- Geriatric MM patients require careful consideration of frailty and comorbidities when initiating treatment.
- New immunotherapies, including CD38 monoclonal antibodies and bispecific antibodies, offer promising advancements.
- Adapting novel therapies for frail and elderly MM patients is a critical clinical challenge.
Conclusions:
- Personalized treatment strategies are essential for optimizing outcomes in older and frail MM patients.
- Further research is needed to establish the efficacy and safety of novel immunotherapies in geriatric MM populations.
- Integrating frailty assessment into routine care can guide treatment decisions for elderly patients with multiple myeloma.
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