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Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN)

  • Palumbo, Antonio Myeloma Unit, Division of Hematology, University of Torino, Azinda Ospedaliero-Universitaria S. Giovanni Battista, Torino, Italy;
  • Bringhen, Sara Myeloma Unit, Division of Hematology, University of Torino, Azinda Ospedaliero-Universitaria S. Giovanni Battista, Torino, Italy;
  • Ludwig, Heinz Department of Medicine I, Center of Oncology and Hematology, Wilhelminenspital, Vienna, Austria;
  • Dimopoulos, Meletios A. Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra General Hospital, Athens, Greece;
  • Bladé, Joan Department of Hematology, Hospital Clinic, Barcelona, Spain;
  • Mateos, Maria V. Servicio de Hematología, Hospital Universitario de Salamanca, and Centro de Investigacion del Cancer, Instituto de Biologia Moleculary Cellular del Cancer (Universdad de Salamanca–Consejo Superior de Investigaciones Cientifica), Salamanca, Spain;
  • Rosiñol, Laura Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain;
  • Boccadoro, Mario Myeloma Unit, Division of Hematology, University of Torino, Azinda Ospedaliero-Universitaria S. Giovanni Battista, Torino, Italy;
  • Cavo, Michele Istituto di Ematologia Seràgnoli, Università degli Studi di Bologna, Bologna, Italy;
  • Lokhorst, Henk Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands;
  • Zweegman, Sonja Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands;
  • Terpos, Evangelos Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra General Hospital, Athens, Greece;
  • Davies, Faith Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom;
  • Driessen, Christoph Department of Oncology/Hematology, Kantonsspital St Gallen, St Gallen, Switzerland;
  • Gimsing, Peter Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark;
  • Gramatzki, Martin Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, University of Kiel, Kiel, Germany;
  • Hàjek, Roman Department of Internal Medicine and Hemato-oncology, Faculty of Hospital Brno and Babak Research Institute, Faculty of Medicine, Masaryk University, Brno-město, Czech Republic;
  • Johnsen, Hans E. Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark;
  • Leal Da Costa, Fernando Department of Hematology, Instituto Português de Oncologia, Lisbon, Portugal;
  • Sezer, Orhan Department of Hematology and Oncology, University Medical Center, Hamburg, Germany;
  • Spencer, Andrew Malignant Hematology and Stem Cell Transplantation Service, Alfred Hospital, Victoria, Australia;
  • Beksac, Meral Department of Hematology, Ankara University, Ankara, Turkey;
  • Morgan, Gareth Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom;
  • Einsele, Hermann Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany; and
  • San Miguel, Jesus F. Servicio de Hematología, Hospital Universitario de Salamanca, and Centro de Investigacion del Cancer, Instituto de Biologia Moleculary Cellular del Cancer (Universdad de Salamanca–Consejo Superior de Investigaciones Cientifica), Salamanca, Spain;
  • Sonneveld, Pieter Department of Hematology, University Hospital Rotterdam, Rotterdam, The Netherlands
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Published in:
  • Blood. - American Society of Hematology. - 2011, vol. 118, no. 17, p. 4519-4529
English Abstract
Most patients with newly diagnosed multiple myeloma (MM) are aged > 65 years with 30% aged > 75 years. Many elderly patients are also vulnerable because of comorbidities that complicate the management of MM. The prevalence of MM is expected to rise over time because of an aging population. Most elderly patients with MM are ineligible for autologous transplantation, and the standard treatment has, until recently, been melphalan plus prednisone. The introduction of novel agents, such as thalidomide, bortezomib, and lenalidomide, has improved outcomes; however, elderly patients with MM are more susceptible to side effects and are often unable to tolerate full drug doses. For these patients, lower-dose-intensity regimens improve the safety profile and thus optimize treatment outcome. Further research into the best treatment strategies for vulnerable elderly patients is urgently needed. Appropriate screening for vulnerability and an assessment of cardiac, pulmonary, renal, hepatic, and neurologic functions, as well as age > 75 years, at the start of therapy allows treatment strategies to be individualized and drug doses to be tailored to improve tolerability and optimize efficacy. Similarly, occurrence of serious nonhematologic adverse events during treatment should be carefully taken into account to adjust doses and optimize outcomes.
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  • English
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https://sonar.ch/global/documents/86852
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