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New Strategies for the Treatment of Older Myeloma Patients

SIMPLE SUMMARY: While novel therapies have improved outcomes in multiple myeloma (MM), physicians are calling for greater caution when managing this hematologic malignancy in older patients due to their fragility, which increases their vulnerability to toxic events. Additionally, this patient popula...

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Autores principales: Larocca, Alessandra, Cani, Lorenzo, Bertuglia, Giuseppe, Bruno, Benedetto, Bringhen, Sara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216689/
https://www.ncbi.nlm.nih.gov/pubmed/37345030
http://dx.doi.org/10.3390/cancers15102693
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author Larocca, Alessandra
Cani, Lorenzo
Bertuglia, Giuseppe
Bruno, Benedetto
Bringhen, Sara
author_facet Larocca, Alessandra
Cani, Lorenzo
Bertuglia, Giuseppe
Bruno, Benedetto
Bringhen, Sara
author_sort Larocca, Alessandra
collection PubMed
description SIMPLE SUMMARY: While novel therapies have improved outcomes in multiple myeloma (MM), physicians are calling for greater caution when managing this hematologic malignancy in older patients due to their fragility, which increases their vulnerability to toxic events. Additionally, this patient population may be excluded from clinical trials due to comorbidities, whereby available data are not always applicable in real-word clinical practice. This review delves into available frailty assessment tools that can be used to identify patients who are unfit or frail and tailor therapy to achieve better outcomes while minimizing toxicity. Current therapeutic strategies for managing transplant-ineligible patients with newly diagnosed MM and relapsed or refractory MM are also described, with the aim of guiding physicians when selecting treatment options. ABSTRACT: Multiple myeloma (MM) mostly affects older patients, who represent a highly heterogeneous population. In the last few years, the introduction of novel agents led to a significant improvement in the outcome of MM patients. Nonetheless, this positive trend is less likely to occur in all older patients due to comorbidities/disabilities and major susceptibility to toxic events. Furthermore, older patients with major comorbidities are usually excluded or underrepresented in most registrational clinical trials. In this context, physicians have called for greater caution in the management of the disease. Several scores allow for the identification of frail and unfit patients and establish the possibility of tailoring therapy, reducing toxicity. This review explores the available tools for the assessment of frailty and what has been done to improve the discriminative power of the available scores. Thereafter, it describes the main therapeutic strategies for the management of transplant-ineligible (NTE) newly diagnosed (ND) MM patients and relapsed/refractory (RR) MM patients, in order to better guide physicians in choosing treatment options and to suggest possible strategies for more frail patients.
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spelling pubmed-102166892023-05-27 New Strategies for the Treatment of Older Myeloma Patients Larocca, Alessandra Cani, Lorenzo Bertuglia, Giuseppe Bruno, Benedetto Bringhen, Sara Cancers (Basel) Review SIMPLE SUMMARY: While novel therapies have improved outcomes in multiple myeloma (MM), physicians are calling for greater caution when managing this hematologic malignancy in older patients due to their fragility, which increases their vulnerability to toxic events. Additionally, this patient population may be excluded from clinical trials due to comorbidities, whereby available data are not always applicable in real-word clinical practice. This review delves into available frailty assessment tools that can be used to identify patients who are unfit or frail and tailor therapy to achieve better outcomes while minimizing toxicity. Current therapeutic strategies for managing transplant-ineligible patients with newly diagnosed MM and relapsed or refractory MM are also described, with the aim of guiding physicians when selecting treatment options. ABSTRACT: Multiple myeloma (MM) mostly affects older patients, who represent a highly heterogeneous population. In the last few years, the introduction of novel agents led to a significant improvement in the outcome of MM patients. Nonetheless, this positive trend is less likely to occur in all older patients due to comorbidities/disabilities and major susceptibility to toxic events. Furthermore, older patients with major comorbidities are usually excluded or underrepresented in most registrational clinical trials. In this context, physicians have called for greater caution in the management of the disease. Several scores allow for the identification of frail and unfit patients and establish the possibility of tailoring therapy, reducing toxicity. This review explores the available tools for the assessment of frailty and what has been done to improve the discriminative power of the available scores. Thereafter, it describes the main therapeutic strategies for the management of transplant-ineligible (NTE) newly diagnosed (ND) MM patients and relapsed/refractory (RR) MM patients, in order to better guide physicians in choosing treatment options and to suggest possible strategies for more frail patients. MDPI 2023-05-10 /pmc/articles/PMC10216689/ /pubmed/37345030 http://dx.doi.org/10.3390/cancers15102693 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Larocca, Alessandra
Cani, Lorenzo
Bertuglia, Giuseppe
Bruno, Benedetto
Bringhen, Sara
New Strategies for the Treatment of Older Myeloma Patients
title New Strategies for the Treatment of Older Myeloma Patients
title_full New Strategies for the Treatment of Older Myeloma Patients
title_fullStr New Strategies for the Treatment of Older Myeloma Patients
title_full_unstemmed New Strategies for the Treatment of Older Myeloma Patients
title_short New Strategies for the Treatment of Older Myeloma Patients
title_sort new strategies for the treatment of older myeloma patients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216689/
https://www.ncbi.nlm.nih.gov/pubmed/37345030
http://dx.doi.org/10.3390/cancers15102693
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