title: Managing multiple myeloma in the over 70s: a review.
abstract: Multiple myeloma (MM) remains an incurable malignancy. Approximately 37% of patients with plasma cell myeloma are over the age of 75 and the median age of diagnosis is 70. The management approach to over 70s differs from younger patients, as treatment goals may vary and underlying co-morbidities and expected treatment related toxicities have to be taken into account. Individualisation of management is important, aiming to achieve the best response whilst minimising adverse events. A proportion of patients will be unable to tolerate any treatment with palliation being appropriate. Age alone should not be a barrier to treatment however, with some fit patients over the age of 70 potentially benefitting from intensive treatment options including high dose chemotherapy with autologous stem cell rescue. Comprehensive geriatric assessment is indicated in the over 70s; this should be employable in a clinic outpatient setting to make it feasible. Outcomes of this assessment potentially help physicians' choice of therapy. For decades the combination of Melphalan and prednisolone was the standard of care for older MM patients. Over the last ten years, newer drugs and combinations have improved therapeutic options for patients but are yet to demonstrate vast improvement in overall survival in this cohort.
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK. Electronic address: andrew.king@ouh.nhs.uk.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: King
authors.affiliation: University Of Oxford, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gooding
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK; NIHR BRC Blood Theme, Oxford, UK.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramasamy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D064592:Autografts; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D000069286:Bortezomib / Q000008:administration & dosage; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004164:Diphosphonates / Q000627:therapeutic use; D050815:Fractures, Compression / Q000209:etiology / Q000601:surgery; D015577:Geriatric Assessment; D006801:Humans; D000077269:Lenalidomide; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D010166:Palliative Care; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D054854:Vertebroplasty
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D003520:Cyclophosphamide; D000077269:Lenalidomide; D008558:Melphalan
keywords: Autologous stem cell transplant; Elderly; Myeloma; Therapy