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Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population

  • Multiple Myeloma (P Kapoor, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Approximately one half of the patient-population in multiple myeloma (MM) is > 70 years at diagnosis. Despite notable strides in the management and improved survival, MM remains incurable, with an increasing proportion of elderly patients comprising the relapsed-refractory cohort.

Recent Findings

The arbitrary age cutoff at 65 years to define the elderly patient-population has evolved to a more nuanced categorization, incorporating a comprehensive assessment for determining frailty prior to commencing treatment. This step is critical in determining the therapy-intensity, including transplant-eligibility, to minimize toxicity. Dose-modifications are crucial, as the merits of continuous therapy are becoming evident in this patient-population. Bortezomib, lenalidomide, and dexamethasone (VRd) combination has emerged as standard of care for newly diagnosed MM. Fixed-duration Rd followed by reduced-dosed continuous R may be considered in select frail patients with standard-risk MM.

Summary

Herein, we review the unique challenges encountered in elderly MM and discuss strategies for optimal management.

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    Saurabh Zanwar, Jithma Prasad Abeykoon & Prashant Kapoor

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Prashant Kapoor reports grants from GSK, grants from TAKEDA, grants from SANOFI, grants from AMGEN, and grants from JANNSEN, outside the submitted work. Saurabh Zanwar and Jithma Prasad Abeykoon declare that they have no conflict of interest.

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Zanwar, S., Abeykoon, J.P. & Kapoor, P. Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population. Curr Hematol Malig Rep 14, 70–82 (2019). https://doi.org/10.1007/s11899-019-00500-4

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