TY - JOUR
T1 - New treatment approaches for older adults with multiple myeloma
AU - Wildes, Tanya M.
AU - Vij, Ravi
AU - Petersdorf, Stephen H.
AU - Medeiros, Bruno C.
AU - Hurria, Arti
N1 - Funding Information:
Dr. Wildes' research is supported by NIH/NCI Washington University — KM1 Grant Number KM1CA156708-01. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIC or NIH.
Funding Information:
Dr. Wildes' research is supported by NIH/NCI Washington University — KM1 grant number KM1CA156708-01 . Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIC or NIH.
PY - 2012/7
Y1 - 2012/7
N2 - The incidence of multiple myeloma (MM) increases with age, and with the aging of the population, the number of adults with MM is expected to double in the next 20 years. Novel agents, including the immunomodulatory agents thalidomide and lenalidomide, and the proteosome inhibitor bortezomib have dramatically changed the treatment of multiple myeloma in the past decade. The purpose of this review was to examine the recent clinical therapeutic trials in older adults with MM. A number of trials have evaluated the addition of novel agents to the traditional backbone of melphalan and prednisone. The combination of thalidomide with melphalan and prednisone has been evaluated in 7 randomized trials. The combination improves response rates and, in meta-analyses, survival, but at the expense of increased toxicity. Other combination regimens that include lenalidomide or bortezomib likewise are associated with higher response rates, but at the expense of greater toxicity. High dose dexamethasone is excessively toxic in older adults and should be avoided. The roles for high-dose therapy with autologous stem cell transplant or intermediate-dose melphalan with autologous stem cell transplant in older adults with MM in the era of modern therapy remain to be defined. In summary, there are a number of new therapeutic options for older adults with MM, allowing an individualized treatment strategy based on the patient's comorbidities and goals of care.
AB - The incidence of multiple myeloma (MM) increases with age, and with the aging of the population, the number of adults with MM is expected to double in the next 20 years. Novel agents, including the immunomodulatory agents thalidomide and lenalidomide, and the proteosome inhibitor bortezomib have dramatically changed the treatment of multiple myeloma in the past decade. The purpose of this review was to examine the recent clinical therapeutic trials in older adults with MM. A number of trials have evaluated the addition of novel agents to the traditional backbone of melphalan and prednisone. The combination of thalidomide with melphalan and prednisone has been evaluated in 7 randomized trials. The combination improves response rates and, in meta-analyses, survival, but at the expense of increased toxicity. Other combination regimens that include lenalidomide or bortezomib likewise are associated with higher response rates, but at the expense of greater toxicity. High dose dexamethasone is excessively toxic in older adults and should be avoided. The roles for high-dose therapy with autologous stem cell transplant or intermediate-dose melphalan with autologous stem cell transplant in older adults with MM in the era of modern therapy remain to be defined. In summary, there are a number of new therapeutic options for older adults with MM, allowing an individualized treatment strategy based on the patient's comorbidities and goals of care.
KW - Aging
KW - Chemotherapy
KW - Geriatrics
KW - Immunomodulatory agents
KW - Multiple myeloma
KW - Proteosome inhibitors
UR - http://www.scopus.com/inward/record.url?scp=84862506391&partnerID=8YFLogxK
U2 - 10.1016/j.jgo.2012.02.001
DO - 10.1016/j.jgo.2012.02.001
M3 - Review article
C2 - 23024730
AN - SCOPUS:84862506391
SN - 1879-4068
VL - 3
SP - 279
EP - 290
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 3
ER -