title: Multiple myeloma in the very elderly patient: challenges and solutions.
abstract: Diagnosis and management of myeloma in the very elderly patient is challenging. Treatment options have vastly improved for elderly myeloma patients but still require the clinician to personalize therapy. In this paper, we offer evidence-based, pragmatic advice on how to overcome six of the main challenges likely to arise: 1) diagnosis of myeloma in this age group, 2) assessment of the need for treatment, and the fitness for combination chemotherapy, 3) provision of the best quality of supportive care, 4) choice of combination chemotherapy in those fit enough for it, 5) treatment of relapsed myeloma, and 6) provision of end of life care. With an increased burden of comorbidities and a reduced resilience to treatment and its associated toxicities, the management of myeloma in this age group requires a different approach to that in younger patients to maximize both quality and length of life.
authors.affiliation: Department of Hematology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK.
authors.forename: John
authors.initials: J
authors.lastname: Willan
authors.affiliation: Department of Hematology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK; Early Phase Clinical Trial Unit, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK.
authors.forename: Toby A
authors.initials: TA
authors.lastname: Eyre
authors.affiliation: Department of Hematology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK.
authors.forename: Faye
authors.initials: F
authors.lastname: Sharpley
authors.affiliation: Department of Hematology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Watson
authors.affiliation: Department of Hematology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK; Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: King
authors.affiliation: Department of Hematology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Churchill Hospital, Oxford, UK; National Institute for Health Research (NIHR) Biomedical Research Center Blood Theme, Oxford, UK.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramasamy
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D016330:Frail Elderly; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013727:Terminal Care
keywords: diagnosis; elderly; myeloma; treatment