Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy.
Blood Rev. 2013 May;27(3):133-42. doi: 10.1016/j.blre.2013.04.001. Epub 2013 Apr 25.
Two-thirds of patients with multiple myeloma are aged 65 years or more and the prevalence of multiple myeloma in elderly patients is expected to rise in the next future. Patients older than 65 years are usually considered ineligible for transplantation. The introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, combined with conventional chemotherapy, has radically changed the treatment paradigm of elderly patients and improved outcome. A sequential approach, consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy, induces a profound cytoreduction and delays relapse, thus improving survival. Novel agents associated with reduced-intensity autologous transplant showed to be safe and effective in fit elderly patients. Patients older than 75 years or vulnerable ones are more susceptible to adverse events that negatively affect treatment adherence and outcome. In this setting, less toxic regimens and appropriate dose reductions should be adopted. Here we provide an overview of novel agent-based treatment strategies for elderly patients with multiple myeloma.
三分之二的多发性骨髓瘤患者年龄在 65 岁或以上，预计未来老年患者多发性骨髓瘤的患病率将会上升。年龄大于 65 岁的患者通常被认为不符合移植条件。新型药物的出现，如免疫调节剂沙利度胺和来那度胺以及蛋白酶体抑制剂硼替佐米，与常规化疗联合使用，彻底改变了老年患者的治疗模式，并改善了预后。一种序贯方法，包括与高完全缓解率相关的诱导方案，随后进行巩固/维持治疗，可诱导深度细胞减少并延迟复发，从而提高生存率。与减强度自体移植相关的新型药物在适合的老年患者中显示出安全性和有效性。年龄大于 75 岁或身体虚弱的患者更容易发生不良事件，从而影响治疗的依从性和结果。在这种情况下，应采用毒性较小的方案和适当的剂量减少。本文将概述多发性骨髓瘤老年患者的新型药物治疗策略。
