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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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).
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.
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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