Myeloma Unit, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
Blood. 2015 Nov 5;126(19):2179-85. doi: 10.1182/blood-2015-05-612960. Epub 2015 Aug 31.
Multiple myeloma is a disease typical of elderly people, with a 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 to 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 as fit or frail according to clinical, functional, cognitive, and socioeconomic criteria. The presence of frailty may complicate the management and outcome of myeloma patients. To date, the choice of treatment of myeloma patients has focused primarily on chronological age and performance status as markers of 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.
多发性骨髓瘤是一种典型的老年疾病，诊断中位年龄为 70 岁。由于新药物的引入，过去几年取得了很大进展。然而，60 至 69 岁的患者的生存率增加幅度要小得多，而老年患者则没有改善。此外，目前批准的治疗方案是在临床试验中根据严格的纳入标准进行测试的。衰老与虚弱的高发率有关，即由于生理储备的严重下降，导致对压力源的易感性增加的状态。老年人可以根据临床、功能、认知和社会经济标准来分类为健康或虚弱。虚弱的存在可能会使骨髓瘤患者的治疗和预后复杂化。迄今为止，骨髓瘤患者的治疗选择主要集中在年龄和身体状况作为脆弱性的标志物上。然而，老年人群高度异质，需要改进评估策略来确定患者的虚弱特征，并为他们提供最合适的治疗，从而避免对虚弱患者过度治疗和对健康患者治疗不足。老年评估是评估认知和功能状态的基本工具。
