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How I treat fragile myeloma patients.
Blood. 2015 Aug 31;
Authors: Larocca A, Palumbo A
Abstract
Multiple myeloma is a disease typical of elderly people, with median age at diagnosis of 70 years. Much progress has been made in the past few years thanks to the introduction of new drugs. However, increases in survival were much less pronounced in patients aged 60-69 years, and no improvement was seen in older patients. Furthermore the currently approved treatment regimens were tested in clinical trials with stringent inclusion criteria. Aging is associated with a high prevalence of frailty, that is a state of increased vulnerability to stressors due to a critical decline in physiologic reserves. Elderly people may be categorized into fit or frail according to clinical, functional, cognitive and socio-economic criteria. The presence of frailty may complicate the management and outcome of myeloma patients. To date, the choice of treatment for myeloma patients has been primarily focused on chronologic age and performance status, as surrogate markers for frailty. However, the elderly population is highly heterogeneous and improved assessment strategies are needed to define the frailty profile of patients and provide them with the most adequate treatment, thus avoiding the overtreatment of frail patients and the undertreatment of fit patients. The geriatric assessment is a fundamental tool for the evaluation of cognitive and functional status.
PMID: 26324701 [PubMed - as supplied by publisher]