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New treatment approaches for older adults with multiple myeloma

Journal of Geriatric Oncology, 3, 3, pages 279 - 290

Abstract

The incidence of multiple myeloma (MM) increases with age, and with the aging of the population, the number of adults with MM is expected to double in the next 20 years. Novel agents, including the immunomodulatory agents thalidomide and lenalidomide, and the proteosome inhibitor bortezomib have dramatically changed the treatment of multiple myeloma in the past decade. The purpose of this review was to examine the recent clinical therapeutic trials in older adults with MM. A number of trials have evaluated the addition of novel agents to the traditional backbone of melphalan and prednisone. The combination of thalidomide with melphalan and prednisone has been evaluated in 7 randomized trials. The combination improves response rates and, in meta-analyses, survival, but at the expense of increased toxicity. Other combination regimens that include lenalidomide or bortezomib likewise are associated with higher response rates, but at the expense of greater toxicity. High dose dexamethasone is excessively toxic in older adults and should be avoided. The roles for high-dose therapy with autologous stem cell transplant or intermediate-dose melphalan with autologous stem cell transplant in older adults with MM in the era of modern therapy remain to be defined. In summary, there are a number of new therapeutic options for older adults with MM, allowing an individualized treatment strategy based on the patient's comorbidities and goals of care.

Keywords: Multiple myeloma, Geriatrics, Aging, Chemotherapy, Immunomodulatory agents, Proteosome inhibitors.

Footnotes

a Washington University School of Medicine, St Louis, MO, USA

b Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA

c Stanford University School of Medicine, Stanford, CA, USA

d City of Hope Comprehensive Cancer Center, Los Angeles, CA, USA

lowast Corresponding author at: 660 South Euclid, Campus Box 8056, St Louis, MO 63110, USA. Tel.: + 1 314 362 5654; fax: + 1 314 362 5123.