title: Nuances in the Management of Older People With Multiple Myeloma.
abstract: Multiple myeloma is a disease of the elderly, with about a third of patients at diagnosis older than 75 years of age. Yet, the population of elderly patients is heterogeneous: older patients are more likely to have comorbidities and frailties complicating both their initial diagnosis and subsequent management, but these are not consistent across the group. Furthermore, patients with comorbidities and frailty are generally underrepresented in clinical trials. Despite the survival of myeloma patients increasing following the introduction of novel agents, older patients continue to have worse outcomes with increased treatment-related toxicity. Treatment tolerability is not defined by age alone, rather a combination of age, physical function, cognitive function, and comorbidities. These factors all influence patients' tolerability of treatment and therefore treatment efficacy and should also be considered when reviewing the results of clinical trials. It is the nuances of determining how these factors interact that should influence initial treatment and ongoing management decisions and these will be discussed here.
authors.affiliation: The Institute of Cancer Research, 15, Cotswold Rd, Sutton, Surrey, SM2 5NG, UK.|The Royal Marsden Hospital NHS Foundation Trust, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Pawlyn
authors.affiliation: Dipartimento di Oncologia ed Ematologia, SC Ematologia 1, A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, C.so Bramante 88/90, 10126, Torino, Italy.|Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gay
authors.affiliation: Dipartimento di Oncologia ed Ematologia, SC Ematologia 1, A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, C.so Bramante 88/90, 10126, Torino, Italy.|Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Larocca
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. Ailawadhi.Sikander@mayo.edu.
authors.forename: Sikander
authors.initials: S
authors.lastname: Ailawadhi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006402:Hematologic Diseases / Q000209:etiology; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D061988:Proteasome Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D061988:Proteasome Inhibitors; D013792:Thalidomide; D003907:Dexamethasone
keywords: Elderly; Multiple myeloma; Treatment