João Cristina, Geraldes Catarina, Neves Manuel, Mariz Mário, Trigo Fernanda
Hemato-Oncology Unit, Champalimaud Centre for the Unknown, Lisboa, Avenida Brasília, 1400-038, Portugal; Nova Medical School, Lisboa, Portugal - Campo Mártires da Pátria 130, 1169-056, Portugal.
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal - Praceta, Rua Professor Mota Pinto, 3004-561, Portugal.
J Geriatr Oncol. 2020 Nov;11(8):1210-1216. doi: 10.1016/j.jgo.2020.06.002. Epub 2020 Jun 27.
The management of older patients with Multiple Myeloma (MM) is particularly challenging due to the highly heterogeneous nature of this population, both in terms of physical and cognitive functioning. Older patients may be divided into fit, intermediate and frail, with variable abilities to tolerate treatments. A careful and correct assessment of the frailty status is thus paramount for the success of therapy and for improving outcomes. With the aging of the European population, the number of older patients with MM is rapidly growing. We hereby present the deliberations and recommendations from an expert panel of Portuguese hematologists conducted to discuss the management of this population, including how to stratify and treat older patients with MM according to their frailty status. The use of frailty tools is critical for the development of individualized risk-adapted treatment strategies and to minimize the risk of under or overtreatment. Aggressive therapies should be used in fitter patients to improve survival outcomes, while frail patients should generally be treated with less toxic approaches to control symptoms while minimizing toxicity. In intermediate-fit patients, low-dose triplets are recommended to achieve a balance between improving survival and maintaining quality of life. The management of older patients with MM should be performed by a multidisciplinary team in view of their advanced age and high prevalence of comorbidities. The inclusion of older and frail patients in future clinical trials investigating treatment regimens for MM is crucial to evaluate treatment feasibility and to improve clinical decision making in this population.
由于老年多发性骨髓瘤（MM）患者群体在身体和认知功能方面具有高度异质性，因此对这部分患者的管理极具挑战性。老年患者可分为健康、中等和虚弱三类，其耐受治疗的能力各不相同。因此，对虚弱状态进行仔细且正确的评估对于治疗的成功及改善预后至关重要。随着欧洲人口老龄化，老年MM患者数量正在迅速增加。在此，我们展示了葡萄牙血液学家专家小组的讨论结果和建议，该小组旨在探讨这一患者群体的管理，包括如何根据老年MM患者的虚弱状态进行分层和治疗。使用虚弱评估工具对于制定个体化的风险适应性治疗策略以及将治疗不足或过度治疗的风险降至最低至关重要。对于身体状况较好的患者应采用积极的治疗方法以改善生存结局，而对于虚弱患者，一般应采用毒性较小的方法来控制症状，同时将毒性降至最低。对于身体状况中等的患者，建议使用低剂量三联疗法，以在改善生存和维持生活质量之间取得平衡。鉴于老年MM患者年龄较大且合并症患病率较高，其管理应由多学科团队进行。将老年和虚弱患者纳入未来研究MM治疗方案的临床试验对于评估治疗的可行性以及改善该患者群体的临床决策至关重要。
