TY - JOUR
T1 - Transplant-ineligible newly diagnosed multiple myeloma
T2 - Current and future approaches to clinical care: A Young International Society of Geriatric Oncology Review Paper
AU - Grant, Shakira J.
AU - Mian, Hira S.
AU - Giri, Smith
AU - Boutin, Melina
AU - Dottorini, Lorenzo
AU - Neuendorff, Nina R.
AU - Krok-Schoen, Jessica L.
AU - Nikita, Nikita
AU - Rosko, Ashley E.
AU - Wildes, Tanya M.
AU - Zweegman, Sonja
N1 - Funding Information: Dr. Neuendorff has received honoraria and travel support from Janssen-Cilag, Medac, Novartis, and Jazz Pharmaceutical. Dr. Mian has received honoraria/consultancy fees from Celgene, Janssen, Amgen, Takeda, and Sanofi. Dr. Giri has received honoraria from Carevive Systems. Dr. Rosko has received consulting funding from ACCC and unpaid-advisory board and travel support from Jazz. Dr. Tanya Wildes receives research funding from Janssen and has served as a consultant for Seattle Genetics and Carevive Systems. Dr. Sonja Zweegman has received research funding from Takeda Janssen and has served on advisory boards for Janssen, Takeda, Celgene, Oncopeptides, and Sanofi. Funding Information: Dr. Grant is supported by National Heart Lung and Blood Institute Grant No. (#T32 HL 007093, PI: Janis Abkowitz). Dr. Giri is supported in part by the Walter B. Frommeyer Fellowship in Investigative Medicine at the University of Alabama at Birmingham and reports receiving research funding from Carevive Systems and Pack Health. Dr. Rosko is supported by National Cancer Institute Grant No. ( NCI K23 CA208010-01 ). Dr. Rosko also receives research support as the site-PI Janssen and Millenium Regeneron. Funding Information: Dr. Grant is supported by National Heart Lung and Blood Institute Grant No. (#T32 HL 007093, PI: Janis Abkowitz). Dr. Giri is supported in part by the Walter B. Frommeyer Fellowship in Investigative Medicine at the University of Alabama at Birmingham and reports receiving research funding from Carevive Systems and Pack Health. Dr. Rosko is supported by National Cancer Institute Grant No. (NCI K23 CA208010-01). Dr. Rosko also receives research support as the site-PI Janssen and Millenium Regeneron. Publisher Copyright: © 2020 Elsevier Inc.
PY - 2021/5
Y1 - 2021/5
N2 - Multiple myeloma is the second most common hematological malignancy in the USA and Europe. Despite improvements in the 5-year and overall survival rates over the past decade, older adults (aged ≥65 years) with multiple myeloma continue to experience disproportionately worse outcomes than their younger counterparts. These differences in outcomes arise from the increased prevalence of vulnerabilities such as medical comorbidities and frailty seen with advancing age that can influence treatment-delivery and tolerance and impact survival. In general, geriatric assessments can help identify those patients more likely to benefit from enhanced toxicity risk-prediction and aid treatment decision-making. Despite the observed benefits of geriatric assessments and other screening frailty tools, provider and systems-level barriers continue to influence the overall perception of the feasibility of geriatric assessments in clinical practice settings. Clinical trials are underway evaluating the efficacy and safety of various multiple myeloma therapies in less fit/frail older adults, with a minority examining fitness-based/risk-adapted approaches. Thus, significant gaps exist in knowing which myeloma therapies are most appropriate for older and more vulnerable adults with multiple myeloma. The purpose of this Review is to discuss how geriatric assessments can be used to guide the management of transplant-ineligible patients; and to highlight frontline therapies for standard-risk and high-risk cytogenetic abnormalities [i.e., t(4;14), t(14;16), and del(17p)] associated with multiple myeloma. We also discuss the current shortcomings of the existing clinical approaches to care and highlight ongoing clinical trials evaluating newer fitness-based approaches to managing transplant-ineligible patients.
AB - Multiple myeloma is the second most common hematological malignancy in the USA and Europe. Despite improvements in the 5-year and overall survival rates over the past decade, older adults (aged ≥65 years) with multiple myeloma continue to experience disproportionately worse outcomes than their younger counterparts. These differences in outcomes arise from the increased prevalence of vulnerabilities such as medical comorbidities and frailty seen with advancing age that can influence treatment-delivery and tolerance and impact survival. In general, geriatric assessments can help identify those patients more likely to benefit from enhanced toxicity risk-prediction and aid treatment decision-making. Despite the observed benefits of geriatric assessments and other screening frailty tools, provider and systems-level barriers continue to influence the overall perception of the feasibility of geriatric assessments in clinical practice settings. Clinical trials are underway evaluating the efficacy and safety of various multiple myeloma therapies in less fit/frail older adults, with a minority examining fitness-based/risk-adapted approaches. Thus, significant gaps exist in knowing which myeloma therapies are most appropriate for older and more vulnerable adults with multiple myeloma. The purpose of this Review is to discuss how geriatric assessments can be used to guide the management of transplant-ineligible patients; and to highlight frontline therapies for standard-risk and high-risk cytogenetic abnormalities [i.e., t(4;14), t(14;16), and del(17p)] associated with multiple myeloma. We also discuss the current shortcomings of the existing clinical approaches to care and highlight ongoing clinical trials evaluating newer fitness-based approaches to managing transplant-ineligible patients.
KW - Frailty
KW - Geriatric assessments
KW - Multiple myeloma
KW - Newly diagnosed multiple myeloma
KW - Older adults
KW - Transplant-ineligible
UR - http://www.scopus.com/inward/record.url?scp=85099505603&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jgo.2020.12.001
DO - https://doi.org/10.1016/j.jgo.2020.12.001
M3 - Review article
C2 - 33342724
SN - 1879-4068
VL - 12
SP - 499
EP - 507
JO - Journal of geriatric oncology
JF - Journal of geriatric oncology
IS - 4
ER -