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Updated: Jun 26, 2025
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Personalized Treatment of Multiple Myeloma in Frail Patients
Jodi J Lipof1, Nadine Abdallah2, Brea Lipe3
1Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA.
Purpose Of Review:
As the treatment landscape for multiple myeloma (MM) continues to expand at a rapid pace, management of older adults and frail patients becomes increasingly challenging. As these patients have traditionally been underrepresented on clinical trials, there is limited guidance on the optimal approach to frail patients with newly diagnosed multiple myeloma (NDMM) or relapsed and refractory multiple myeloma (RRMM).
Recent Findings:
Frailty is an independent predictor of tolerability and response to antineoplastic treatment. Stringent eligibility criteria have often excluded these patients, but recently some large trials have included frailty sub-analyses to help guide management. In general, triplet regimens are preferred to doublet regimens in this population and enrollment on a clinical trial should be prioritized when possible. In this review, we summarize the MM frailty scoring tools that have been developed to identify and assess this vulnerable population. We present the clinical trials over the past decade that have enrolled frail patients and/or have included subgroup analyses to help elucidate the response and tolerability of different regimens in this underrepresented group. We provide practical advice regarding assessment and management of frail patients NDMM and RRMM.
Insights
Managing frail patients with multiple myeloma (MM) is challenging. Triplet regimens are preferred, and clinical trials are crucial for this underrepresented group with newly diagnosed or relapsed/refractory MM.
Area of Science:
- Hematology
- Geriatric Oncology
- Clinical Trial Design
Background:
- The expanding treatment options for multiple myeloma (MM) present challenges in managing older and frail patients.
- Frail patients are often underrepresented in clinical trials, leading to limited guidance for newly diagnosed (NDMM) and relapsed/refractory (RRMM) disease.
Purpose of the Study:
- To review frailty assessment tools for multiple myeloma.
- To summarize clinical trial data on frail patients with NDMM and RRMM.
- To provide practical management advice for frail patients with multiple myeloma.
Main Methods:
- Literature review of clinical trials and frailty scoring tools over the past decade.
- Analysis of subgroup data focusing on frail patient populations.
- Synthesis of evidence to guide the assessment and management of frail patients.
Main Results:
- Frailty is a significant predictor of treatment tolerability and response in multiple myeloma.
- Triplet regimens are generally preferred over doublet regimens for frail patients.
- Prioritizing enrollment in clinical trials is recommended for this vulnerable population.
Conclusions:
- Effective assessment and management strategies are needed for frail patients with multiple myeloma.
- Clinical trials are essential for gathering data and improving outcomes in this underrepresented group.
- Tailored treatment approaches, prioritizing triplet regimens and clinical trial participation, can optimize care for frail patients.
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