Multiple myeloma in the very old: an IASIA conference report.
Multiple myeloma (MM) in patients aged greater than 80 years poses an increasingly common challenge for oncology providers. A multidisciplinary workshop was held in which MM-focused hematologists/oncologists, geriatricians, and associated health-care team members discussed the state of research for MM therapy, as well as themes from geriatric medicine that pertain directly to this patient population. A summary statement of our discussions is presented here, in which we highlight several topics. MM disproportionately affects senior adults, and demographic trends indicate that this trend will accelerate. Complex issues impact cancer in seniors, and although factors such as social environment, comorbidities, and frailty have been well characterized in nononcological geriatric medicine, these themes have been inadequately explored in cancers such as MM, despite their clear relevance to this field. Therapeutically, novel agents have improved survival for MM patients of all ages, but less so for seniors than younger patients for a variety of reasons. Lastly, both MM- and treatment-related symptoms and toxicities require special attention in senior adults. Existing research provides limited insight into how best to manage these often complex patients, who are often not reflected in typical clinical trial populations. We hence offer suggestions for clinical trials that address knowledge gaps in how to manage very old and/or frail patients with MM, given the complicated issues that often surround this patient population.
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY). sat6@duke.edu.
Sascha A
SA
Tuchman
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Gary R
GR
Shapiro
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
William B
WB
Ershler
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Ashraf
A
Badros
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Harvey J
HJ
Cohen
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Angela
A
Dispenzieri
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Irene Q
IQ
Flores
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Bindu
B
Kanapuru
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Donald
D
Jurivich
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Dan L
DL
Longo
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Ali
A
Nourbakhsh
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Antonio
A
Palumbo
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Jeremy
J
Walston
Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
Jerome W
JW
Yates
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018426:SEER Program; D014481:United States / Q000453:epidemiology