Mina Roberto, Bringhen Sara, Wildes Tanya M, Zweegman Sonja, Rosko Ashley E
1 Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
2 Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:500-518. doi: 10.1200/EDBK_239067. Epub 2019 May 17.
Multiple myeloma (MM) is a disease of aging adults, and numerous therapeutic options are available for this growing demographic. MM treatment of older adults continues to evolve and includes novel combinations, new generations of targeted agents, immunotherapy, and increasing use of autologous stem cell transplantation (ASCT). Understanding age-related factors, independent of chronologic age itself, is an increasingly recognized factor in MM survivorship, especially in understudied populations, such as octogenarians. Octogenarians have inferior survival that cannot be explained by cytogenetic profiles alone. Incorporating assessments of geriatric factors can provide guidance on how to intensify or de-escalate therapeutic options. Functional status, using objective testing, is superior to traditional metrics of performance status and should be implemented to optimize the risk-benefit ratio of ASCT. ASCT is feasible and cost-effective, and chronologic age should not exclude ASCT eligibility. Upfront ASCT remains the standard of care, in the context of a sequential approach that includes pre-transplantation induction and post-transplantation maintenance. High-risk MM is classically defined by disease characteristics, yet shifting frameworks suggest that the high-risk designation could refer to any patient subgroup who is at risk for poorer outcomes-beyond disease-focused outcomes to patient-focused outcomes. Defining the optimal treatment of subgroups of older patients with high-risk disease on the basis of chromosomal abnormalities is unexplored. Here, we review tools to assess individual health status, explore vulnerability in octogenarians with MM, address ASCT decision-making, and examine high-risk MM to understand factors that contribute to survival disparities for older adults with MM.
多发性骨髓瘤（MM）是一种老年疾病，对于这一不断增长的人群有多种治疗选择。老年MM患者的治疗在持续发展，包括新型联合疗法、新一代靶向药物、免疫疗法以及自体干细胞移植（ASCT）使用的增加。了解与年龄相关的因素（独立于实际年龄本身）在MM生存中是一个日益被认可的因素，尤其是在研究较少的人群中，如八旬老人。八旬老人的生存率较低，这不能仅通过细胞遗传学特征来解释。纳入老年因素评估可为如何强化或降低治疗方案提供指导。通过客观测试得出的功能状态优于传统的体能状态指标，应采用功能状态来优化ASCT的风险效益比。ASCT是可行且具有成本效益的，实际年龄不应排除ASCT的资格。在包括移植前诱导和移植后维持的序贯治疗方法中，早期ASCT仍然是标准治疗方案。高危MM传统上由疾病特征定义，但不断变化的框架表明，高危 designation可能指任何有预后较差风险的患者亚组——从以疾病为重点的预后到以患者为重点的预后。基于染色体异常确定老年高危疾病患者亚组的最佳治疗方法尚未得到探索。在此，我们回顾评估个体健康状况的工具，探讨MM八旬老人的脆弱性，解决ASCT决策问题，并研究高危MM以了解导致老年MM患者生存差异的因素。
