Skip to main content
SpringerLink
Log in

Personalized Treatment of Multiple Myeloma in Frail Patients

  • REVIEW
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

As the treatment landscape for multiple myeloma (MM) continues to expand at a rapid pace, management of older adults and frail patients becomes increasingly challenging. As these patients have traditionally been underrepresented on clinical trials, there is limited guidance on the optimal approach to frail patients with newly diagnosed multiple myeloma (NDMM) or relapsed and refractory multiple myeloma (RRMM).

Recent Findings

Frailty is an independent predictor of tolerability and response to antineoplastic treatment. Stringent eligibility criteria have often excluded these patients, but recently some large trials have included frailty sub-analyses to help guide management. In general, triplet regimens are preferred to doublet regimens in this population and enrollment on a clinical trial should be prioritized when possible.

Summary

In this review, we summarize the MM frailty scoring tools that have been developed to identify and assess this vulnerable population. We present the clinical trials over the past decade that have enrolled frail patients and/or have included subgroup analyses to help elucidate the response and tolerability of different regimens in this underrepresented group. We provide practical advice regarding assessment and management of frail patients NDMM and RRMM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cancer Stat Facts: Myeloma. 2020 [Available from: https://seer.cancer.gov/statfacts/html/mulmy.html.

  2. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538–48.

    Article  PubMed  Google Scholar 

  3. Costa LJ, Brill IK, Omel J, Godby K, Kumar SK, Brown EE. Recent trends in multiple myeloma incidence and survival by age, race, and ethnicity in the United States. Blood Adv. 2017;1(4):282–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Huang J, Chan SC, Lok V, Zhang L, Lucero-Prisno DE 3rd, Xu W, et al. The epidemiological landscape of multiple myeloma: a global cancer registry estimate of disease burden, risk factors, and temporal trends. Lancet Haematol. 2022;9(9):e670–7.

    Article  CAS  PubMed  Google Scholar 

  5. Turesson I, Bjorkholm M, Blimark CH, Kristinsson S, Velez R, Landgren O. Rapidly changing myeloma epidemiology in the general population: Increased incidence, older patients, and longer survival. Eur J Haematol. 2018;101:237.

    Article  Google Scholar 

  6. Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia. 2014;28(5):1122–8.

    Article  CAS  PubMed  Google Scholar 

  7. Puertas B, González-Calle V, Sobejano-Fuertes E, Escalante F, Queizán JA, Bárez A, et al. Novel Agents as Main Drivers for Continued Improvement in Survival in Multiple Myeloma. Cancers. 2023;15(5):1558.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sedrak MS, Freedman RA, Cohen HJ, Muss HB, Jatoi A, Klepin HD, et al. Older adult participation in cancer clinical trials: A systematic review of barriers and interventions. CA Cancer J Clin. 2021;71(1):78–92.

    Article  PubMed  Google Scholar 

  9. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  PubMed  Google Scholar 

  10. Stege CAM, van der Holt B, Dinmohamed AG, Sonneveld P, Levin MD, van de Donk N, et al. Validation of the FIRST simplified frailty scale using the ECOG performance status instead of patient-reported activities. Leukemia. 2020;34(7):1964–6.

    Article  PubMed  Google Scholar 

  11. Palumbo A, Bringhen S, Mateos M-V, Larocca A, Facon T, Kumar SK, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 2015;125(13):2068–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Delforge M, Raddoux J, Kenis C, Vanhellemont A, Mineur P, Hoornaert E, et al. P-162: Compass: a prospective study comparing clinical evaluation with different geriatric screening methods in newly diagnosed elderly multiple myeloma patients. Clin Lymphoma Myeloma Leuk. 2021;21:S124.

    Article  Google Scholar 

  13. Broderick JM, Hussey J, Kennedy MJ, O’Donnell DM. Patients over 65 years are assigned lower ECOG PS scores than younger patients, although objectively measured physical activity is no different. J Geriatr Oncol. 2014;5(1):49–56.

    Article  PubMed  Google Scholar 

  14. Schnadig ID, Fromme EK, Loprinzi CL, Sloan JA, Mori M, Li H, Beer TM. Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer. Cancer. 2008;113(8):2205–14.

    Article  PubMed  Google Scholar 

  15. Klepin HD, Geiger AM, Tooze JA, Kritchevsky SB, Williamson JD, Pardee TS, et al. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Blood. 2013;121(21):4287–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Hamaker ME, Stauder R, van Munster BC. Exclusion of older patients from ongoing clinical trials for hematological malignancies: an evaluation of the National Institutes of Health Clinical Trial Registry. Oncologist. 2014;19(10):1069–75.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ramjaun A, Nassif MO, Krotneva S, Huang AR, Meguerditchian AN. Improved targeting of cancer care for older patients: a systematic review of the utility of comprehensive geriatric assessment. J Geriatr Oncol. 2013;4(3):271–81.

    Article  PubMed  Google Scholar 

  18. Freyer G, Geay JF, Touzet S, Provencal J, Weber B, Jacquin JP, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol. 2005;16(11):1795–800.

    Article  CAS  PubMed  Google Scholar 

  19. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Mian H, McCurdy A, Giri S, Grant S, Rochwerg B, Winks E, et al. The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review. Blood Cancer J. 2023;13(1):6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mian H, Wildes TM, Vij R, Pianko MJ, Major A, Fiala MA. Dynamic frailty risk assessment among older adults with multiple myeloma: A population-based cohort study. Blood Cancer J. 2023;13(1):76.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Engelhardt M, Domm AS, Dold SM, Ihorst G, Reinhardt H, Zober A, et al. A concise revised Myeloma Comorbidity Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients. Haematologica. 2017;102(5):910–21.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dold SM, Möller MD, Ihorst G, Langer C, Pönisch W, Mügge LO, et al. Validation of the revised myeloma comorbidity index and other comorbidity scores in a multicenter German study group multiple myeloma trial. Haematologica. 2021;106(3):875–80.

    Article  PubMed  Google Scholar 

  24. Cook G, Royle KL, Pawlyn C, Hockaday A, Shah V, Kaiser MF, et al. A clinical prediction model for outcome and therapy delivery in transplant-ineligible patients with myeloma (UK Myeloma Research Alliance Risk Profile): a development and validation study. Lancet Haematol. 2019;6(3):e154–66.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Milani P, Vincent Rajkumar S, Merlini G, Kumar S, Gertz MA, Palladini G, et al. N-terminal fragment of the type-B natriuretic peptide (NT-proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma. Am J Hematol. 2016;91(11):1129–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Facon T, Dimopoulos MA, Meuleman N, Belch A, Mohty M, Chen WM, et al. A simplified frailty scale predicts outcomes in transplant-ineligible patients with newly diagnosed multiple myeloma treated in the FIRST (MM-020) trial. Leukemia. 2020;34(1):224–33.

    Article  PubMed  Google Scholar 

  27. Wildes TM, Tuchman SA, Klepin HD, Mikhael J, Trinkaus K, Stockerl-Goldstein K, et al. Geriatric assessment in older adults with multiple myeloma. J Am Geriatr Soc. 2019;67(5):987–91.

    Article  PubMed  Google Scholar 

  28. Murillo A, Cronin AM, Laubach JP, Hshieh TT, Tanasijevic AM, Richardson PG, et al. Performance of the International Myeloma Working Group myeloma frailty score among patients 75 and older. J Geriatr Oncol. 2019;10(3):486–9.

    Article  PubMed  Google Scholar 

  29. Soto-Perez-de-Celis E, Li D, Yuan Y, Lau YM, Hurria A. Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol. 2018;19(6):e305–16.

    Article  PubMed  Google Scholar 

  30. Bonanad S, De la Rubia J, Gironella M, Pérez Persona E, González B, Fernández Lago C, et al. Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale. J Geriatr Oncol. 2015;6(5):353–61.

    Article  CAS  PubMed  Google Scholar 

  31. Kleber M, Ihorst G, Terhorst M, Koch B, Deschler B, Wäsch R, Engelhardt M. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM-comorbidity score. Blood Cancer J. 2011;1(9): e35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gay F, Larocca A, Wijermans P, Cavallo F, Rossi D, Schaafsma R, et al. Complete response correlates with long-term progression-free and overall survival in elderly myeloma treated with novel agents: analysis of 1175 patients. Blood. 2011;117(11):3025–31.

    Article  CAS  PubMed  Google Scholar 

  33. Migkou M, Kastritis E, Roussou M, Gkotzamanidou M, Gavriatopoulou M, Nikitas N, et al. Short progression-free survival predicts for poor overall survival in older patients with multiple myeloma treated upfront with novel agent-based therapy. Eur J Haematol. 2011;87(4):323–9.

    Article  CAS  PubMed  Google Scholar 

  34. Dimopoulos MA, Kastritis E, Delimpasi S, Katodritou E, Hatzimichael E, Kyrtsonis MC, et al. Multiple myeloma in octogenarians: clinical features and outcome in the novel agent era. Eur J Haematol. 2012;89(1):10–5.

    Article  CAS  PubMed  Google Scholar 

  35. Lee HC, Ailawadhi S, Gasparetto CJ, Jagannath S, Rifkin RM, Durie BGM, et al. Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect(®) MM Registry. Blood Cancer J. 2021;11(7):134.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fakhri B, Fiala MA, Tuchman SA, Wildes TM. Undertreatment of Older Patients With Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies. Clin Lymphoma Myeloma Leuk. 2018;18(3):219–24.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bringhen S, Mateos MV, Zweegman S, Larocca A, Falcone AP, Oriol A, et al. Age and organ damage correlate with poor survival in myeloma patients: meta-analysis of 1435 individual patient data from 4 randomized trials. Haematologica. 2013;98(6):980–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Larocca A, Bonello F, Gaidano G, D’Agostino M, Offidani M, Cascavilla N, et al. Dose/schedule-adjusted Rd-R vs continuous Rd for elderly, intermediate-fit patients with newly diagnosed multiple myeloma. Blood. 2021;137(22):3027–36.

    Article  CAS  PubMed  Google Scholar 

  39. Pawlyn C, Cairns D, Kaiser M, Striha A, Jones J, Shah V, et al. The relative importance of factors predicting outcome for myeloma patients at different ages: results from 3894 patients in the Myeloma XI trial. Leukemia. 2020;34(2):604–12.

    Article  CAS  PubMed  Google Scholar 

  40. Celis ESPD, Li D, Sun C-L, Kim H, Twardowski P, Fakih M, et al. Patient-defined goals and preferences among older adults with cancer starting chemotherapy (CT). J Clin Oncol. 2018;36(15_suppl):10009.

    Article  Google Scholar 

  41. McKay C, Maiese EM, Chiarappa J, Cambron-Mellott MJ, Maculaitis M, Alunni N, Raje N. Patient preferences for multiple myeloma (MM) treatment: interim analysis of a discrete choice experiment. Blood. 2018;132(Supplement 1):3586.

    Article  Google Scholar 

  42. Mikhael J, Ismaila N, Cheung MC, Costello C, Dhodapkar MV, Kumar S, et al. Treatment of multiple myeloma: ASCO and CCO Joint clinical practice guideline. J Clin Oncol. 2019;37(14):1228–63.

    Article  PubMed  Google Scholar 

  43. Munshi PN, Vesole D, Jurczyszyn A, Zaucha JM, St Martin A, Davila O, et al. Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma. Cancer. 2020;126(23):5077–87.

    Article  PubMed  Google Scholar 

  44. Muchtar E, Dingli D, Kumar S, Buadi FK, Dispenzieri A, Hayman SR, et al. Autologous stem cell transplant for multiple myeloma patients 70 years or older. Bone Marrow Transplant. 2016;51(11):1449–55.

    Article  CAS  PubMed  Google Scholar 

  45. Badros A, Barlogie B, Siegel E, Roberts J, Langmaid C, Zangari M, et al. Results of autologous stem cell transplant in multiple myeloma patients with renal failure. Br J Haematol. 2001;114(4):822–9.

    Article  CAS  PubMed  Google Scholar 

  46. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8):2912–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Attal M, Lauwers-Cances V, Hulin C, Leleu X, Caillot D, Escoffre M, et al. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma. N Engl J Med. 2017;376(14):1311–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Giri S, Aryal MR, Yu H, Grimshaw A, Pathak R, Huntington SP, Dhakal B. Efficacy and safety of frontline regimens for older transplant-ineligible patients with multiple myeloma: A systematic review and meta-analysis. J Geriatr Oncol. 2020;11(8):1285–92.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Durie BGM, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet. 2017;389(10068):519–27.

    Article  CAS  PubMed  Google Scholar 

  50. DuMontier C, La J, Bihn J, Corrigan J, Yildirim C, Dharne M, et al. More intensive therapy has a better effect for frail parents with multiple myeloma. Blood Adv. 2023;7(20):6275–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. O’Donnell EK, Laubach JP, Yee AJ, Chen T, Huff CA, Basile FG, et al. A phase 2 study of modified lenalidomide, bortezomib and dexamethasone in transplant-ineligible multiple myeloma. Br J Haematol. 2018;182(2):222–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Kumar SK, Moreau P, Bahlis NJ, Facon T, Plesner T, Orlowski RZ, et al. Daratumumab Plus Lenalidomide and Dexamethasone (D-Rd) Versus Lenalidomide and Dexamethasone (Rd) Alone in Transplant-Ineligible Patients with Newly Diagnosed Multiple Myeloma (NDMM): Updated Analysis of the Phase 3 Maia Study. Blood. 2022;140(Supplement 1):10150–3.

    Article  Google Scholar 

  53. Facon T, Cook G, Usmani SZ, Hulin C, Kumar S, Plesner T, et al. Daratumumab plus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of MAIA. Leukemia. 2022;36(4):1066–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Mateos MV, Dimopoulos MA, Cavo M, Suzuki K, Knop S, Doyen C, et al. Daratumumab Plus Bortezomib, Melphalan, and Prednisone Versus Bortezomib, Melphalan, and Prednisone in Transplant-Ineligible Newly Diagnosed Multiple Myeloma: Frailty Subgroup Analysis of ALCYONE. Clin Lymphoma Myeloma Leuk. 2021;21(11):785–98.

    Article  CAS  PubMed  Google Scholar 

  55. San-Miguel J, Avet-Loiseau H, Paiva B, Kumar S, Dimopoulos MA, Facon T, et al. Sustained minimal residual disease negativity in newly diagnosed multiple myeloma and the impact of daratumumab in MAIA and ALCYONE. Blood. 2022;139(4):492–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Perrot A, Facon T, Plesner T, Usmani S, Kumar SK, Bahlis NJ, et al. Health-Related Quality of Life for Frail Transplant-Ineligible Patients with Newly Diagnosed Multiple Myeloma Treated with Daratumumab, Lenalidomide and Dexamethasone: Subgroup Analysis of MAIA Trial. Blood. 2022;140(Supplement 1):1142–5.

    Article  Google Scholar 

  57. Benboubker L, Dimopoulos MA, Dispenzieri A, Catalano J, Belch AR, Cavo M, et al. Lenalidomide and Dexamethasone in Transplant-Ineligible Patients with Myeloma. N Engl J Med. 2014;371(10):906–17.

    Article  CAS  PubMed  Google Scholar 

  58. Manier S, Corre J, Hulin C, Laribi K, Araujo C, Pica G-M, et al. A dexamethasone sparing-regimen with daratumumab and lenalidomide in frail patients with newly-diagnosed multiple myeloma: efficacy and safety analysis of the phase 3 IFM2017-03 Trial. Blood. 2022;140(Supplement 1):1369–70.

    Article  Google Scholar 

  59. Lokhorst HM, Plesner T, Laubach JP, Nahi H, Gimsing P, Hansson M, et al. Targeting CD38 with Daratumumab Monotherapy in Multiple Myeloma. N Engl J Med. 2015;373(13):1207–19.

    Article  CAS  PubMed  Google Scholar 

  60. Markovic U, Romano A, Del Fabro V, Bellofiore C, Bulla A, Parisi MS, et al. Daratumumab as single agent in relapsed/refractory myeloma patients: a retrospective real-life survey. Front Oncol. 2021;11: 624405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Attal M, Richardson PG, Rajkumar SV, San-Miguel J, Beksac M, Spicka I, et al. Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): a randomised, multicentre, open-label, phase 3 study. Lancet. 2019;394(10214):2096–107.

    Article  CAS  PubMed  Google Scholar 

  62. Dimopoulos MA, Terpos E, Boccadoro M, Delimpasi S, Beksac M, Katodritou E, et al. Daratumumab plus pomalidomide and dexamethasone versus pomalidomide and dexamethasone alone in previously treated multiple myeloma (APOLLO): an open-label, randomised, phase 3 trial. Lancet Oncol. 2021;22(6):801–12.

    Article  CAS  PubMed  Google Scholar 

  63. Bahlis NJ, Dimopoulos MA, White DJ, Benboubker L, Cook G, Leiba M, et al. Daratumumab plus lenalidomide and dexamethasone in relapsed/refractory multiple myeloma: extended follow-up of POLLUX, a randomized, open-label, phase 3 study. Leukemia. 2020;34(7):1875–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Mateos MV, Sonneveld P, Hungria V, Nooka AK, Estell JA, Barreto W, et al. Daratumumab, Bortezomib, and Dexamethasone Versus Bortezomib and Dexamethasone in Patients With Previously Treated Multiple Myeloma: Three-year Follow-up of CASTOR. Clin Lymphoma Myeloma Leuk. 2020;20(8):509–18.

    Article  PubMed  Google Scholar 

  65. Usmani SZ, Quach H, Mateos MV, Landgren O, Leleu X, Siegel D, et al. Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): updated outcomes from a randomised, multicentre, open-label, phase 3 study. Lancet Oncol. 2022;23(1):65–76.

    Article  CAS  PubMed  Google Scholar 

  66. Moreau P, Dimopoulos MA, Mikhael J, Yong K, Capra M, Facon T, et al. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): a multicentre, open-label, randomised phase 3 trial. Lancet. 2021;397(10292):2361–71.

    Article  CAS  PubMed  Google Scholar 

  67. Schjesvold F, Bringhen S, Richardson PG, Perrot A, Leleu X, Moreau P, et al. Isatuximab plus pomalidomide and dexamethasone in frail patients with relapsed/refractory multiple myeloma: ICARIA-MM subgroup analysis. Am J Hematol. 2021;96(11):E423–7.

    Article  CAS  PubMed  Google Scholar 

  68. Facon T, Niesvizky R, Mateos M-V, Siegel D, Rosenbaum C, Bringhen S, et al. Efficacy and safety of carfilzomib-based regimens in frail patients with relapsed and/or refractory multiple myeloma. Blood Adv. 2020;4(21):5449–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Auner HW, Gavriatopoulou M, Delimpasi S, Simonova M, Spicka I, Pour L, et al. Effect of age and frailty on the efficacy and tolerability of once-weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma. Am J Hematol. 2021;96(6):708–18.

    Article  CAS  PubMed  Google Scholar 

  70. Berdeja JG, Madduri D, Usmani SZ, Jakubowiak A, Agha M, Cohen AD, et al. Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b/2 open-label study. Lancet. 2021;398(10297):314–24.

    Article  CAS  PubMed  Google Scholar 

  71. Rodriguez-Otero P, Ailawadhi S, Arnulf B, Patel K, Cavo M, Nooka AK, et al. Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2023;388(11):1002–14.

    Article  CAS  PubMed  Google Scholar 

  72. Moreau P, Garfall AL, van de Donk N, Nahi H, San-Miguel JF, Oriol A, et al. Teclistamab in Relapsed or Refractory Multiple Myeloma. N Engl J Med. 2022;387(6):495–505.

    Article  CAS  PubMed  Google Scholar 

  73. Munshi NC, Anderson LD Jr, Shah N, Madduri D, Berdeja J, Lonial S, et al. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2021;384(8):705–16.

    Article  CAS  PubMed  Google Scholar 

  74. Akhtar OS, Sheeba BA, Azad F, Alessi L, Hansen D, Alsina M, et al. Safety and efficacy of anti-BCMA CAR-T cell therapy in older adults with multiple myeloma: A systematic review and meta-analysis. J Geriatr Oncol. 2023;15:101628.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA

    Jodi J. Lipof & Brea Lipe

  2. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Nadine Abdallah

Authors
  1. Jodi J. Lipof
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nadine Abdallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brea Lipe
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jodi Lipof, Nadine Abdallah, and Brea Lipe all contributed to writing and reviewing the article.

Corresponding author

Correspondence to Brea Lipe.

Ethics declarations

Competing interests

Brea Lipe has research funding from Amgen and Janssen and is an advisor for Janssen, BMS, Pfizer, and Sanofi.

Conflict of Interest

Jodi Lipof declares no conflict of interest. Nadine Abdallah declares no conflict of interest. Brea Lipe***

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Keypoints

• Treatment decisions in older patients with MM should take into account disease stage and aggressiveness, comorbidities, adherence, social support, travel burden, and individual preferences.

• A geriatric assessment should be performed at baseline to guide treatment choice, and throughout treatment to guide dose/schedule modifications.

• Several frailty tools are available in MM; the choice should be based on institutional resources.

• Triplets are more efficacious than doublets in both newly diagnosed and relapsed/refractory settings, but may be associated with higher toxicity and treatment discontinuation.

• DRd and VRd are preferred in fit transplant-ineligible patients. DRd, VRd-Lite, and DR options in intermediate-fit and frail patients.

• Early referral is key in older patients being considered for bispecifics or CAR T-cell therapy.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lipof, J.J., Abdallah, N. & Lipe, B. Personalized Treatment of Multiple Myeloma in Frail Patients. Curr Oncol Rep (2024). https://doi.org/10.1007/s11912-024-01545-2

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11912-024-01545-2

Keywords

Search

Navigation