Abstract
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.
Keywords
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Article info
Publication history
Published online: February 29, 2012
Accepted:
February 7,
2012
Received in revised form:
December 21,
2011
Received:
September 26,
2011
Identification
Copyright
© 2012 Published by Elsevier Inc.
