Modern Treatment Options for Elderly Patients with Multiple Myeloma

Onkologie ◽  
2008 ◽  
Vol 31 (6) ◽  
pp. 10-10
Author(s):  
Martin Görner ◽  
Ernst Späth-Schwalbe
Keyword(s):  
Multiple Myeloma ◽  
Elderly Patients ◽  
Treatment Options ◽  
Modern Treatment

scholarly journals Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3106
Author(s):  
Francesca Bonello ◽  
Mario Boccadoro ◽  
Alessandra Larocca
Keyword(s):  
Multiple Myeloma ◽  
Elderly Patients ◽  
Treatment Options ◽  
Real Life ◽  
Frailty Status ◽  
Frail Patients ◽  
Multidimensional Evaluation ◽  
Choice Of Treatment ◽  
Choice Of Therapy

Multiple myeloma (MM) mostly affects elderly patients, which represent a highly heterogeneous population. Indeed, comorbidities, frailty status and functional reserve may vary considerably among patients with similar chronological age. For this reason, the choice of treatment goals and intensity is particularly challenging in elderly patients, and it requires a multidimensional evaluation of the patients and the disease. In recent years, different tools to detect patient frailty have been developed, and the International Myeloma Working Group frailty score currently represents the gold standard. It identifies intermediate-fit and frail patients requiring gentler treatment approaches compared to fit patients, aiming to preserve quality of life and prevent toxicities. This subset of patients is underrepresented in clinical trials, and studies exploring frailty-adapted approaches are scarce, making the choice of therapy extremely challenging. Treatment options for intermediate-fit and frail patients might include dose-adapted combinations, doublets, and less toxic combinations based on novel agents. This review analyzes the available tools for the assessment of frailty and possible strategies to improve the discriminative power of the scores and expand their use in real-life and clinical trial settings. Moreover, it addresses the main therapeutic challenges in the management of intermediate-fit and frail MM patients at diagnosis and at relapse.

How should we treat newly diagnosed multiple myeloma patients?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 488-495 ◽  
Author(s):  
María-Victoria Mateos ◽  
Jesús F. San Miguel
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Elderly Patients ◽  
Alkylating Agents ◽  
Treatment Options ◽  
Prolonged Treatment ◽  
Term Therapy ◽  
Close Monitoring ◽  
Newly Diagnosed

AbstractMultiple myeloma (MM) is the second most frequent hematological disease. Two-thirds of newly diagnosed MM patients are more than 65 years of age. Elsewhere in this issue, McCarthy et al discuss the treatment of transplantation candidates; this chapter focuses on the data available concerning therapy for non-transplantation-eligible MM patients. Treatment goals for these non-transplantation-eligible patients should be to prolong survival by achieving the best possible response while ensuring quality of life. Until recently, treatment options were limited to alkylators, but new up-front treatment combinations based on novel agents (proteasome inhibitors and immunomodulatory drugs) plus alkylating agents have significantly improved outcomes. Other nonalkylator induction regimens are also available and provide a novel backbone that may be combined with novel second- and third-generation drugs. Phase 3 data indicate that maintenance therapy or prolonged treatment in elderly patients also improves the quality and duration of clinical responses, extending time to progression and progression-free survival; however, the optimal scheme, appropriate doses, and duration of long-term therapy have not yet been fully determined. The potential for novel treatment regimens to improve the adverse prognosis associated with high-risk cytogenetic profiles also requires further research. In summary, although we have probably doubled the survival of elderly patients, this group requires close monitoring and individualized, dose-modified regimens to improve tolerability and treatment efficacy while maintaining their quality of life.

scholarly journals Management of multiple myeloma in the newly diagnosed patient

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 498-507 ◽  
Author(s):  
María-Victoria Mateos ◽  
Jesús F. San Miguel
Keyword(s):  
Multiple Myeloma ◽  
Elderly Patients ◽  
Hematopoietic Cell Transplantation ◽  
Treatment Options ◽  
Young Patients ◽  
New Drugs ◽  
Novel Agents ◽  
Term Therapy ◽  
High Dose ◽  
Newly Diagnosed

AbstractMultiple myeloma is the second most frequent hematological disease. The introduction of melphalan as high-dose therapy followed by autologous hematopoietic cell transplantation (HDT/ASCT) for young patients and the availability of novel agents for young and elderly patients with multiple myeloma have dramatically changed the perspective of treatment. However, further research is necessary if we want definitively to cure the disease. Treatment goals for transplant-eligible and non–transplant-eligible patients should be to prolong survival by achieving the best possible response while ensuring quality of life. For young patients, HDT-ASCT is a standard of care for treatment, and its efficacy has been enhanced and challenged by the new drugs. For elderly patients, treatment options were once limited to alkylators, but new upfront treatment combinations based on novel agents (proteasome inhibitors and immunomodulatory drugs) combined or not with alkylators have significantly improved outcomes. Extended treatment of young and elderly patients improves the quality and duration of clinical responses; however, the optimal scheme, appropriate doses, and duration of long-term therapy have not yet been fully determined. This review summarizes progress in the treatment of patients with newly diagnosed multiple myeloma, addressing critical questions such as the optimal induction, early vs late ASCT, consolidation and/or maintenance for young patients, and how we can choose the best treatment option for non–transplant-eligible patients.

scholarly journals High-Dose Therapy (HDT) with Melphalan and Autologous Stem Cell Transplantation (ASCT) for Patients Older Than 70 Years with Multiple Myeloma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3461-3461 ◽  
Author(s):  
Hendrik Brockhoff ◽  
Christian Meyer zum Büschenfelde ◽  
Murwan Ayoub ◽  
Hartmut Goldschmidt ◽  
Hans-Juergen Salwender
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Renal Failure ◽  
Elderly Patients ◽  
Conflicts Of Interest ◽  
Treatment Options ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Tandem Therapy

Abstract Background: During the last 15 years there has been a substantial improvement in treatment options for patients with multiple myeloma. For patients younger than 65 years high dose chemotherapy with melphalan and autologous stem cell transplantation is still regarded as the standard therapy. This very effective treatment regimen is now widely used for more than 20 years. However, the therapy of elderly patients (> 70 years) with HDT-ASCT has only been a reserved option for a selected group of patients with a lower biological age. Therefore, for these patients only few studies have analyzed the role of HDT-ASCT regarding overall survival (OS), progression free survival (PFS) and risk assessment-which is our study subject. In addition we want to compare HDT-ASCT with the current standard of treatment for older patients like the continuous lenalidomide and dexamethasone regime (Rd) or bortezomib based regimes. Method: We retrospectively analyzed 62 elderly patients with a median age at ASCT of 71.3 years with multiple myeloma who underwent HDT-ASCT treatment at the Asklepios Hospital Altona in Hamburg, Germany between 2004 and 2013 (3 previously treated with HDT-ASCT and 59 previously untreated). Overall these patients received 86 ASCT. Primary scopes of interest were OS, PFS and treatment related mortality (TRM). Secondary outcome variables were melphalan-dosage, chronic renal failure (Durie Salmon stage A/B), tandem-therapy, ISS-Score, as well as best response after therapy. OS was calculated from beginning of therapy until death of any cause. PFS was calculated from beginning of therapy until progression. Results: The median OS was 60.8 months. TRM was 0%. Median PFS was 33.3 months (n=40). The following factors were significant regarding OS: 1. Chronic renal failure (39 vs. 65.6 months; p=0.03). 2. Higher ISS-Score (ISS III: 33.7 vs. ISS I/II: 76.7 months; p= 0.013). The following factors showed a non statistically significant trend regarding OS: 1. High melphalan dosage, at least once 200mg/m² melphalan, during HDCT-ASCT (70.3 vs. 53 months; p=0.1). 2. Response after therapy (complete remission (CR) / very good partial remission (VGPR): 74.6 vs. partial remission / minimal remission / stable disease: 59.4 months; p= 0.088). 3. Tandem therapy (single transplantation: 60.6 vs. tandem transplantation: 96.3 months; p= 0.127). Conclusion: With a median OS of more than 5 years and a TRM of 0% high dose chemotherapy with melphalan is a valid treatment option for selected elderly patients with multiple myeloma aged > 70 years. The median OS and PFS (60.8 months; 33.3 months) in our patient group was higher than published data with lenalidomide or bortezomib based treatments (e.g. Rd), which has a median OS of 58.9 months and a of PFS 26 month (Facon et al. 2015, Clinical Lymphoma Myeloma and Leukemia, Vol: 15, p: e134). At relapse fewer patients are eligible for HDT-ASCT than de novo patients, therefore HDT-ASCT should be used as first line therapy for suitable patients. Adverse effects of long time glucocorticoid, bortezomib and lenalidomide treatment also have a negative impact on the quality of life for myeloma patients and can lead to irreversible medical consequences. Of note, the treatment duration with high dose melphalan is shorter and has a lower cost than other treatment options for multiple myeloma, which can lead to long treatment free intervals and therefore improve the quality of life for patients. Disclosures: No relevant conflicts of interest to declare. Disclosures No relevant conflicts of interest to declare.

Stew in its Own Juice: Protein Homeostasis Machinery Inhibition Reduces Cell Viability in Multiple Myeloma Cell Lines

2019 ◽  
Vol 19 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Mariana B. de Oliveira ◽  
Luiz F.G. Sanson ◽  
Angela I.P. Eugenio ◽  
Rebecca S.S. Barbosa-Dantas ◽  
Gisele W.B. Colleoni
Keyword(s):  
Multiple Myeloma ◽  
Cell Death ◽  
Cell Viability ◽  
Cell Lines ◽  
Treatment Options ◽  
Compensatory Mechanism ◽  
Protein Homeostasis ◽  
Protein Response ◽  
Rpmi 8226

Introduction:Multiple myeloma (MM) cells accumulate in the bone marrow and produce enormous quantities of immunoglobulins, causing endoplasmatic reticulum stress and activation of protein handling machinery, such as heat shock protein response, autophagy and unfolded protein response (UPR).Methods:We evaluated cell lines viability after treatment with bortezomib (B) in combination with HSP70 (VER-15508) and autophagy (SBI-0206965) or UPR (STF- 083010) inhibitors.Results:For RPMI-8226, after 72 hours of treatment with B+VER+STF or B+VER+SBI, we observed 15% of viable cells, but treatment with B alone was better (90% of cell death). For U266, treatment with B+VER+STF or with B+VER+SBI for 72 hours resulted in 20% of cell viability and both treatments were better than treatment with B alone (40% of cell death). After both triplet combinations, RPMI-8226 and U266 presented the overexpression of XBP-1 UPR protein, suggesting that it is acting as a compensatory mechanism, in an attempt of the cell to handle the otherwise lethal large amount of immunoglobulin overload.Conclusion:Our in vitro results provide additional evidence that combinations of protein homeostasis inhibitors might be explored as treatment options for MM.

Real-world treatment patterns in relapsed/refractory multiple myeloma: Clinical and economic outcomes in patients treated with pomalidomide or daratumumab

2021 ◽  
pp. 107815522199553
Author(s):  
Joshua Richter ◽  
Vamshi Ruthwik Anupindi ◽  
Jason Yeaw ◽  
Suneel Kudaravalli ◽  
Stojan Zavisic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Treatment Options ◽  
Proteasome Inhibitors ◽  
Economic Outcomes ◽  
Office Visits ◽  
Refractory Multiple Myeloma ◽  
Kaplan Meier ◽  
Real World Evidence ◽  
New Treatment

Introduction Real-world evidence on later line treatment of relapsed/refractory multiple myeloma (RRMM) is sparse. We evaluated clinical outcomes among RRMM patients in the 1-year following treatment with pomalidomide or daratumumab and compared economic outcomes between RRMM patients and non-MM patients. Patient and Methods Adult patients with ≥1 claim of pomalidomide or daratumumab were identified between January 2012 and February 2018 using IQVIA PharMetrics® Plus US claims database. Patients were required to have a diagnosis or treatment for MM and a claim of any immunomodulatory drugs and proteasome inhibitors before the index date. Mean time to new therapy, overall survival (OS) using Kaplan-Meier curve and adverse events (AEs) were reported over the 1-year post-index period. RRMM patients were also matched to a non-MM comparator cohort and economic outcomes were compared between the two cohorts. Results 289 RRMM patients were matched to 1,445 patients without MM. Most prevalent hematological AE was anemia (72.0%) and non-hematological AE was infections (75.4%). Mean (SD) time to a new treatment was 4.7 (5.3) months and median OS was 14.6 months. RRMM patients had significantly higher hospitalizations and physician office visits (Both P < .0001) compared to non-MM patients. Adjusting for baseline characteristics, patients with RRMM had 4.9 times (95% CI 3.8-6.4, P < .0001) the total healthcare costs compared with patients without MM. The major driver of total costs among RRMM patients was pharmacy costs (67.3%). Conclusion RRMM patients showed a high frequency of AEs, low OS, and a substantial economic burden suggesting need for effective treatment options.

scholarly journals Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect® MM Registry

2021 ◽  
Vol 11 (7) ◽  
Author(s):  
Hans C. Lee ◽  
Sikander Ailawadhi ◽  
Cristina J. Gasparetto ◽  
Sundar Jagannath ◽  
Robert M. Rifkin ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Elderly Patients ◽  
Treatment Patterns ◽  
Newly Diagnosed
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