The diagnosis and management of myeloma in the very elderly is especially challenging, despite improvements in therapies. A review study, “Multiple myeloma in the very elderly patient: challenges and solutions, published in Clinical Interventions in Aging, suggested ways of overcoming the difficulties to maximize these patients’ length and quality of life.
New drug development has improved survival rates in younger myeloma patients, but these benefits have yet to be realized in those over age 80. Reasons can range from lack of resilience to physiological stress factors, to poorer overall health, frailty, and co-existing diseases. Myeloma treatment in elderly patients also requires careful clinician oversight, to best personalize the treatment.
In the review, authors offered evidence-based suggestions on overcoming probable challenges, such as the diagnosis of myeloma, assessment of a patient’s treatment options and overall fitness for combination chemotherapy, determining supportive care and combination chemotherapy options, treatment of reoccurring myeloma, and end of life care. Because of comorbidities in people 80 and older, and their reduced resilience to chemotherapy and its related toxicities, myeloma management in this group will need a different approach from that used in younger patients.
Specifically, the authors noted that diagnosing and treating myeloma in people age 80 and older requires careful consideration of treatment timing and aggressiveness. An accurate estimation of fitness should be conducted to determine appropriate treatment intensity. A multidisciplinary team approach, ensuring more supportive care, is also essential for effective chemotherapy. Toxicities can be minimized by reducing doses, if needed to allow continuation of treatment. And new therapies, combining anti-myeloma activity with easier administration and lower toxicity levels, are recommended.
As the population ages, the incidence of myeloma in the elderly is expected to rise. Participation of these patients in clinical trials is crucial to developing therapies of benefit to them, allowing clinicians and patients alike to make better informed, evidence-based decisions on treatment strategies.
Treating myeloma in the elderly is challenging, but with judicious use of supportive and active treatments, effective care can be provided them, the study concluded.
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