Diamond Evan, Lahoud Oscar B, Landau Heather
a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA.
Leuk Lymphoma. 2018 Jun;59(6):1300-1311. doi: 10.1080/10428194.2017.1365859. Epub 2017 Aug 28.
Multiple myeloma (MM) is a plasma cell neoplasm that affects elderly individuals with two-thirds of patients over 65 years at diagnosis. However, data available are derived from clinical trials conducted in younger patients. Fewer studies investigated treatment options in the elderly. This review summarizes the clinical outcomes and toxicities associated with therapeutic regimens in older patients including doublet, triplet and high dose therapyin newly diagnosed patients and relapsed patients with MM. We highlight the importance of an approach tailored to individuals, incorporates the geriatric frailty assessment, considers comorbiditiess and commits to early recognition and management of toxicities ranging from myelosuppression to polypharmacy. To date, no trial has prospectively investigated a tailored treatment paradigm in older patients based on frailty and/or comorbidities. As the population ages, the proportion of MM patients with advanced age will grow. Studies are indicated to determine optimal treatment approaches in this increasingly heterogeneous geriatric population.
多发性骨髓瘤（MM）是一种浆细胞肿瘤，好发于老年人，三分之二的患者在诊断时年龄超过65岁。然而，现有数据来自于在年轻患者中开展的临床试验。针对老年患者治疗方案的研究较少。本综述总结了老年患者（包括初诊患者和复发患者）采用双联、三联和高剂量疗法等治疗方案的临床结局和毒性。我们强调了个体化治疗方法的重要性，这种方法应纳入老年衰弱评估、考虑合并症，并致力于早期识别和管理从骨髓抑制到多重用药等各种毒性。迄今为止，尚无试验前瞻性地研究基于衰弱和/或合并症的老年患者个体化治疗模式。随着人口老龄化，高龄MM患者的比例将会增加。有必要开展研究以确定在这个日益多样化的老年人群中的最佳治疗方法。
