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Multiple myeloma gammopathies

Patient-centered practice in elderly myeloma patients: an overview and consensus from the European Myeloma Network (EMN)

Leukemia volume 32, pages 1697–1712 (2018)Cite this article

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Abstract

Multiple myeloma is a disease typical of the elderly, and, because of the increase in life expectancy of the general population, its incidence is expected to grow in the future. Elderly patients represent a particular challenge due to their marked heterogeneity. Many new and highly effective drugs have been introduced in the last few years and results from clinical trials are promising. Besides the availability of novel agents, a careful evaluation of elderly patients showed to be a key factor for the success of therapy. A geriatric assessment is a valid strategy to better stratify patients. In particular, different scores are available today to appropriately assess elderly patients and define their fitness/frailty status. The choice of treatment—transplantation, triplets, doublets, or reduced-dose therapies including novel agents—should depend on the patient’s fitness status (fit, intermediate-fit or frail). Second-generation novel agents have also been evaluated as salvage therapy in the elderly, and these new agents certainly represent a further step forward in the treatment armamentarium for elderly patients with multiple myeloma.

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Acknowledgements

The expert panel thanks all the investigators of the EMN group in the different countries for their support. This work is supported by the Deutsche Krebshilfe (grants 1095969 and 111424 to ME and RW). HWA acknowledges the support of the Imperial College London National Institute of Health Research-Biomedical Research Centre (NIHR-BRC).

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Authors and Affiliations

  1. Myeloma Unit, Division of Hematology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy

    Alessandra Larocca, Mattia D’Agostino, Francesca Gay, Sara Bringhen & Mario Boccadoro

  2. Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Sandra Maria Dold, Ralph Wäsch, Sophia Scheubeck & Monika Engelhardt

  3. VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Sonja Zweegman

  4. National and Kapodostrian University of Athens, Athens, Greece

    Evangelos Terpos & Meletios A. Dimopoulos

  5. Medizinische Klinik, Abteilung Innere Medizin V, Universitätsklinikum Heidelberg und National Centrum für Tumorerkrankungen (NCT), Heidelberg, Germany

    Hartmut Goldschmidt

  6. Seràgnoli Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy

    Michele Cavo

  7. 1st Medical Department and Oncology, Wilhelminenspital Wien, Vienna, Austria

    Heinz Ludwig

  8. Hematology & Oncology, Klinikum Schwabing, Munich, Germany

    Christian Straka

  9. Centre for Haematology, Department of Medicine, Imperial College London, London, UK

    Holger W. Auner

  10. Department of Hematology, CHU de Liège, Liège, Belgium

    Jo Caers

  11. Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany

    Martin Gramatzki

  12. Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy

    Massimo Offidani

  13. Department of Internal Medicine II, University Hospital Würburg, Würzburg, Germany

    Hermann Einsele

  14. Department of Hematology, Rotterdam, Netherlands

    Pieter Sonneveld

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Corresponding author

Correspondence to Alessandra Larocca.

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Conflict of interest

AL has received honoraria from Amgen, BMS, Celgene, and Janssen-Cilag; ET has received honoraria from Amgen, Celgene, Genesis, Janssen, Novartis, Takeda, Abbvie, BMS, and GSK; research funding from Celgene, Janssen, Amgen; has participated in DMC for Celgene and in SC for Amgen, Takeda and Janssen; HG has received research support from Amgen, BMS, Celgene, Chugai, Janssen, Sanofi, Mundipharma, Takeda, Novartis, honoraria from Celgene, Janssen, Novartis, Chugai, BMS, ArtTempi, and served on the advisory boards of Adaptive Biotechnology, Amgen, BMS, Celgene, Janssen, Sanofi, Takeda; FG has participated in the advisory board of Takeda, Seattle Genetics, Mundipharma, Janssen, and received honoraria from Takeda, Amgen, Celgene, Janssen, BMS; SB has received honoraria from BMS, Celgene, Janssen-Cilag, and participated in the advisory board of Amgen, Mundipharma, Karyopharm; JC has participated in the advisory board of and received honoraria from Amgen, Celgene, Janssen and research funding from Celgene. MO has received honoraria from and participated in advisory board of Celgene, Janssen, Takeda, Amgen, BMS; HWA has received research support from Amgen, participated in the advisory board of and honoraria from Amgen, Takeda, Karyopharm, Chugai, Novartis; HE has received honoraria, research support from and served on the advisory board of Janssen, Celgene, Amgen, BMS, Novartis; MB has received honoraria from Sanofi, Celgene, Amgen, Janssen, Novartis, Abbvie, BMS, and research funding from Celgene, Janssen, Amgen, BMS, Mundipharma, Novartis, Sanofi; PS has participated in the advisory board of and received honoraria from Amgen, Celgene, Janssen, Karyopharm, Takeda-Millennium, and research support from Amgen, Celgene, Janssen, Takeda-Millennium, SkylineDx.

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This manuscript is published as a consensus paper by the European Hematology Association and the European Myeloma Network.

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Larocca, A., Dold, S.M., Zweegman, S. et al. Patient-centered practice in elderly myeloma patients: an overview and consensus from the European Myeloma Network (EMN). Leukemia 32, 1697–1712 (2018). https://doi.org/10.1038/s41375-018-0142-9

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  • DOI: https://doi.org/10.1038/s41375-018-0142-9

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