Myeloma Unit, Division of Hematology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Leukemia. 2018 Aug;32(8):1697-1712. doi: 10.1038/s41375-018-0142-9. Epub 2018 Apr 25.
Multiple myeloma is a disease typical of the elderly, and, because of the increase in life expectancy of the general population, its incidence is expected to grow in the future. Elderly patients represent a particular challenge due to their marked heterogeneity. Many new and highly effective drugs have been introduced in the last few years and results from clinical trials are promising. Besides the availability of novel agents, a careful evaluation of elderly patients showed to be a key factor for the success of therapy. A geriatric assessment is a valid strategy to better stratify patients. In particular, different scores are available today to appropriately assess elderly patients and define their fitness/frailty status. The choice of treatment-transplantation, triplets, doublets, or reduced-dose therapies including novel agents-should depend on the patient's fitness status (fit, intermediate-fit or frail). Second-generation novel agents have also been evaluated as salvage therapy in the elderly, and these new agents certainly represent a further step forward in the treatment armamentarium for elderly patients with multiple myeloma.
多发性骨髓瘤是一种老年人特有的疾病，由于一般人群的预期寿命延长，其发病率预计在未来将会增加。老年患者因其明显的异质性而构成特殊的挑战。在过去的几年中，已经引入了许多新的和高度有效的药物，临床试验的结果很有前景。除了新型药物的应用，对老年患者的仔细评估被证明是治疗成功的关键因素。老年评估是一种更好地对患者进行分层的有效策略。特别是，目前有不同的评分标准可用于适当评估老年患者并确定他们的健康状况。治疗方案的选择——移植、三联疗法、双药联合治疗或包括新型药物的减剂量治疗——应取决于患者的健康状况（健康、中等健康或虚弱）。第二代新型药物也已被评估为老年患者的挽救治疗方法，这些新药物无疑代表了多发性骨髓瘤老年患者治疗手段的进一步发展。
