Assessment and Treatment of Elderly Patients with Multiple Myeloma

Abstract

Multiple myeloma (MM) is an incurable hematological malignancy of the plasma cells. Most patients with MM are older than 65 years. Therefore, it is highly important to perform a frailty assessment to identify which patients are especially vulnerable and at risk of complications. Frailty assessment also allows referral to several specialists (physical therapy, nutrition, neuropsychologist) and can eventually improve patient's tolerance to therapy. It is especially important to offer elderly patients the best MM drugs upfront, as most of them will receive only one line of therapy. However, risk-adapted therapy dosing is recommended at diagnosis in order to reduce toxicities and early deaths. Since a large proportion of older adults seen in clinical practice would not have been included in most clinical trials, more studies focusing on frail and very frail patients with MM are needed. This article provides an overview of methodologies for frailty evaluation, discusses existing therapeutic modalities and offers insights into current treatment perspectives for older patients with newly diagnosed and relapsed/refractory MM. PEER REVIEWED ARTICLE **Peer reviewers:** Dr Amandine Segot, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland Prof. Paul G. Richardson, Dana-Farber Cancer Institute Boston MA, USA Received: February 15, 2024; accepted after peer review: June 14, 2024.