a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy.
Expert Rev Anticancer Ther. 2018 Sep;18(9):917-930. doi: 10.1080/14737140.2018.1496823. Epub 2018 Jul 13.
In the majority of cases, multiple myeloma is a disease occurring in elderly patients. In the last decades, a major improvement in myeloma patients' outcome has been achieved with the introduction of several new drugs. However, this positive outcome was less likely to occur in elderly patients. Areas covered: An overall increase of myeloma cases in elderly patients is expected in the next years. This patient population is highly heterogeneous in terms of physiological functions and ability to resist stressing conditions such as myeloma and its treatment. While physicians cannot prevent the stress arising from the disease itself, the intensity of therapeutic approaches can be tuned according to patients' predicted tolerance. In this review, we focus on the assessment of patients' fitness and on available significant data on treatment efficacy and tolerability in elderly patients. Expert commentary: Fit, elderly patients should undergo full-dose therapy to maximize the depth of response, while intermediate and frail patients benefit from reduced-dose regimens in order to avoid toxicity and preserve quality of life. Ongoing trials will provide further evidence to individualize treatment on the basis of geriatric assessment and disease characteristics.
在大多数情况下，多发性骨髓瘤是一种发生在老年患者中的疾病。在过去的几十年中，随着几种新药的引入，骨髓瘤患者的预后有了显著改善。然而，这种积极的结果在老年患者中不太可能出现。
预计未来几年老年多发性骨髓瘤患者的病例将增加。就生理功能和抵抗骨髓瘤及其治疗等压力条件的能力而言，该患者群体具有高度异质性。虽然医生无法预防疾病本身带来的压力，但可以根据患者的预期耐受性来调整治疗方法的强度。在这篇综述中，我们重点评估了患者的健康状况，以及在老年患者中关于治疗效果和耐受性的现有重要数据。
健康的老年患者应接受全剂量治疗，以最大限度地提高反应深度，而中等和体弱的患者则从减少剂量方案中受益，以避免毒性并保持生活质量。正在进行的试验将根据老年评估和疾病特征提供进一步的证据，使治疗个体化。
