Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-13T07:07:44.621Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of multiple myeloma in older people

Published online by Cambridge University Press:  11 August 2014

E Bolaños ,
B Iñigo ,
C Benavente  and
R Martínez
E Bolaños
Affiliation:
Department of Haematology, Hospital Clinico San Carlos, Madrid, Spain
B Iñigo*
Affiliation:
Department of Haematology, Hospital Clinico San Carlos, Madrid, Spain
C Benavente
Affiliation:
Department of Haematology, Hospital Clinico San Carlos, Madrid, Spain
R Martínez
Affiliation:
Department of Haematology, Hospital Clinico San Carlos, Madrid, Spain
*
Address for correspondence: Dr Belen Iñigo-Rodriguez, Department of Haematology, Hospital Clinico San Carlos, Madrid, Spain. Email: belen.inigo@gmail.com
Get access Rights & Permissions [Opens in a new window]

Summary

Multiple myeloma is a neoplastic proliferation of a plasma cell clone that produces a monoclonal immunoglobulin. It is one of the most common haematological malignancies and the incidence increases with age, with a median age at diagnosis of 65–70 years. The diagnosis of multiple myeloma requires the presence of ≥10% plasma cells in the bone marrow and an M-protein in serum and/or urine. Cytogenetic status, serum β2-microglobulin and response to therapy are the key prognostic factors. Treatment is necessary for the patient diagnosed with symptomatic multiple myeloma, with organ damage. Patients older than 65 years are ineligible for autologous transplantation. The introduction of novel agents, such as thalidomide, bortezomib and lenalidomide, have changed the management of myeloma and extended overall survival. However, in older patients the results are not as satisfactory and treatment strategies have to be individualized to improve tolerability and optimize efficacy.

Keywords

monoclonal gammapathymultiple myelomaolder patientsupportive carebortezomiblenalidomidethalidomide
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 3 , August 2014 , pp. 173 - 181
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Moreau, P, San Miguel, J, Ludwig, H, Schouten, H, Mohty, M, Dimopoulos, M, Dreyling, M; ESMO Guidelines Working Group. Ann Oncol 2013; 24 suppl 6: vi133–37.Google Scholar
2Kyle, RA, Rajkumar, SV. Multiple myeloma. N Engl J Med 2004; 351: 1860–73.Google Scholar
3Palumbo, A, Anderson, K. Multiple Myeloma. N Engl J Med 2011; 364: 1046–60.Google Scholar
4Jemal, A, Siegel, R, Ward, Eet al.Cancer statistics. CA. Cancer J Clin. 2008; 58: 71–96.CrossRefGoogle Scholar
5Kuehl, WM, Bergsagel, PL. Molecular pathogenesis of multiple myeloma and its premalignant precursor. J Clin Invest. 2012; 122: 3456–63.CrossRefGoogle ScholarPubMed
6Mitsiades, CS, Mitsiades, NS, Munshi, NC, Richardson, PG, Anderson, KC. The role of the bone microenviorement in the pathophysiology and therapeutic management of multiple myeloma: interplay f growth factors, their receptors and stromal interactions. Eur J Cancer 2006; 42: 1564–73.Google Scholar
7Podar, K.Niches within the Multiple Myeloma Bone Marrow Microenvironment, ed Kenneth, C, Anderson, M, Ghobrial, I. Multiple Myeloma: Translational and Emerging Therapies, pp. 61–75. Informa Healthcare, New York; 2007.Google Scholar
8Podar, K, Tai, Y-T, Hideshima, T, Vallet, S, Richardson, PG, Anderson, KC. Emerging therapies for multiple myeloma. Expert Opin Emerg Drugs 2009; 14: 99–127.Google Scholar
9International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003; 121: 749–57.Google Scholar
10Kyle, RA, Rajkumar, SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 2009; 23: 3–9.CrossRefGoogle ScholarPubMed
11British Committee for Standards in Haematology in conjunction with the UK Myeloma Forum. Guidelines on the diagnosis and management of multiple myeloma. BCSH, London; 2013.Google Scholar
12Palumbo, A, Gay, F. How to treat elderly patients with multiple myeloma: combination of therapy or sequencing. Hematology Am Soc Hematol Educ Program 2009: 566–77.Google Scholar
13Snozek, CL, Katzmann, JA, Kyle, RAet al.Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: proposed incorporation into the international staging system. Leukemia 2008; 22: 1933–37.CrossRefGoogle ScholarPubMed
14Fonseca, R, Barlogie, B, Bataille, Ret al.Genetics and cytogenetics of multiple myeloma: a workshop report. Cancer Res 2004; 64: 1546–58.CrossRefGoogle ScholarPubMed
15Smadja, NV, Fruchart, C, Isnard, Fet al.Chromosomal analysis in multiple myeloma: cytogenetic evidence of two different diseases. Leukemia 1998; 12: 960–69.CrossRefGoogle ScholarPubMed
16Sawyer, JR. The prognostic significance of cytogenetics and molecular profiling in multiple myeloma. Cancer Genet 2011; 204: 3–12.CrossRefGoogle ScholarPubMed
17Dimopoulos, M, Terpos, E, Comenzo, RL. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia 2009; 23: 1545–56.Google Scholar
18Walker, RC, Brown, TL, Jones-Jackson, LB, De Blanche, L, Bartel, T. Imaging of multiple myeloma and related plasma cell dyscrasias. J Nucl Med 2012; 53: 1091–101.Google Scholar
19Regelink, JC, Minnema, MC, Terpos, E. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol 2013; 162: 50–61.CrossRefGoogle ScholarPubMed
20Palumno, A, Bringhen, S, Ludwig, H. Pesonalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN). Blood 2011; 118: 4519–29.Google Scholar
21Durie, BG, Salmon, SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842–54.Google Scholar
22Greipp, PR, San Miguel, J, Durie, BG. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–20.CrossRefGoogle ScholarPubMed
23Durie, BG, Harousseau, JL, Miguel, JS; International Myeloma Working Group. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–73.Google Scholar
24Kyle, RA, Rajkumar, SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 2009; 23: 3–9.CrossRefGoogle ScholarPubMed
25Bladé, J, Teresa Cibeira, M, Fernández de Larrea, C, Rosiñol, L. Multiple myeloma. Annals of Oncology 21 (suppl 7).Google Scholar
26Oyajobi, BO. Myeloma multiple/hypercalcemia. Arthritis Res Ther 2007; 9 (suppl 1): S4.Google Scholar
27Kyle, RA, Gertz, MA, Witzig, TE. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21–33.Google Scholar
28Snowden, JA, Ahmedzai, SH, Ashcroft, J. Guidelines for supportive care in multiple myeloma 2011. Br J Haematol 2011; 154: 76–103.Google Scholar
29Burnette, BL, Leung, N, Rajkumar, SV. Renal improvement in myeloma with bortezomib plus plasma exchange. N Engl J Med 2011; 364: 2365.Google Scholar
30Nucci, M, Anaissie, E. Infections in patients with multiple myeloma in the era of high-dose therapy and novel agents. Clin Infect Dis 2009; 49: 1211–25.Google Scholar
31Rapezzi, D, Sticchi, L, Racchi, Oet al.Influenza vaccine in chronic lymphoproliferative disorders and multiple myeloma. Eur J Haematol 2003; 70: 225.Google Scholar
32Robertson, JD, Nagesh, K, Jowitt, SNet al.Immunogenicity of vaccination against influenza, Streptococcus pneumoniae and Haemophilus influenzae type B in patients with multiple myeloma. Br J Cancer 2000; 82: 1261.Google Scholar
33Kristinsson, SY, Fears, TR, Gridley, Get al.Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma. Blood 2008; 112: 3582.Google Scholar
34Palumbo, A, Mina, R. Management of older adults with multiple myeloma. Blood Reviews 2013; 27: 133–142.Google Scholar
35Palumbo, A, Gay, F. How to treat elderly patients with multiple myeloma: combination of therapy or sequencing. Hematology Am Soc Hematol Educ Program 2009: 566–77.Google Scholar
36Mehta, J, Cavo, M, Singhal, S. How I treat elderly patients with myeloma. Blood 2010; 116: 2215–23.CrossRefGoogle Scholar
37Klepin, HD, Rizzieri, D, Palumbo, A, Magarotto, V, Eichhorst, B. Individualizing treatment decisions for older adults with hematologic malignancies. Am Soc Clin Oncol Educ Book 2013; 33: 208–19.Google Scholar
38San Miguel, JF, Schlag, R, Khuageva, NKet al.Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Eng J Med 2008; 359: 906–17.Google Scholar
39Mateos, MV, Oriol, A, Martinez, Jet al.Bortezomib (Velcade)-melphalan-prednisone (VMP) versus velcade-thalidomide-prednisone (VTP) in elderly untreated multiple myeloma patients: which is the best partner for Velcade: an alkylating or an immunomodulator agent? Blood 2008; 112: 651.Google Scholar
40Palumbo, A, Bringhen, S, Rossi, Det al.A prospective, randomized, phase III study of bortezomib, melphalan, prednisone and thalidomide (VMPT) versus bortezomib, melphalan and prednisone (VMP) in elderly newly diagnosed myeloma patients. Blood 2008; 112: 652.CrossRefGoogle Scholar
41Rajkumar, SV, JAcobus, S, Callander, NS; Eastern Co-operative Oncology Group. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol 2010; 11: 29–37.Google Scholar