Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Sep 18;52(9):966-974. doi: 10.1093/jjco/hyac111.
Multiple myeloma is a cancer of plasma cells; the incidence rate of multiple myeloma is high among older adults. Although significant advances have been made in the clinical management of multiple myeloma driven by the introduction of novel drugs, such as proteasome inhibitors, immuno- modulators and antibodies, multiple myeloma remains incurable. Hence, the current therapeutic goal for multiple myeloma is to achieve long-term survival while maintaining a good quality of life. In this context, personalized treatment to balance the efficacy and safety of therapies is important, especially for older adults as they display diverse physical, cognitive or organ functioning. Furthermore, old age is also often associated with frailty. Several tools for evaluating frailty in older adults with multiple myeloma are now available, and frail patients defined by these tools have shown a poor prognosis and more treatment-related toxicities. In addition, it is important to evaluate other factors, such as the International Staging System, high-risk chromosomal abnormalities and treatment response, to predict the clinical course of patients. Further investigations are required to determine how these factors can optimize the treatment for multiple myeloma. In this review, we present a detailed account on the developments and issues related to the current treatment approaches for older adults with newly diagnosed multiple myeloma. We also discuss the ongoing phase III clinical study conducted by the lymphoma study group of the Japan Clinical Oncology Group, which targeted older adults with newly diagnosed multiple myeloma.
多发性骨髓瘤是一种浆细胞癌；多发性骨髓瘤在老年人中的发病率较高。尽管新型药物（如蛋白酶体抑制剂、免疫调节剂和抗体）的引入推动了多发性骨髓瘤的临床管理取得了重大进展，但多发性骨髓瘤仍然无法治愈。因此，多发性骨髓瘤的当前治疗目标是在保持生活质量的同时实现长期生存。在这种情况下，平衡治疗效果和安全性的个性化治疗很重要，特别是对于老年人，因为他们的身体、认知或器官功能存在多样性。此外，老年患者还常伴有衰弱。目前已有多种评估多发性骨髓瘤老年患者衰弱的工具，这些工具定义的虚弱患者预后较差，且更容易发生与治疗相关的毒性反应。此外，评估其他因素（如国际分期系统、高危染色体异常和治疗反应）以预测患者的临床病程也很重要。需要进一步的研究来确定这些因素如何优化多发性骨髓瘤的治疗。在这篇综述中，我们详细介绍了新诊断多发性骨髓瘤老年患者当前治疗方法的进展和相关问题。我们还讨论了日本临床肿瘤学组淋巴瘤研究组正在进行的一项针对新诊断多发性骨髓瘤老年患者的 III 期临床研究。
