Frail patients with newly diagnosed multiple myeloma

Abstract

Multiple myeloma (MM) is typical of the elderly, and the median age at diagnosis is 70 years. Because of the increased life expectancy of the general population, the incidence of MM is expected to increase. Traditionally, therapy for MM patients has been selected according to age, and patients aged 65 or less are commonly assigned high-dose therapy and transplantation, while patients older than 65 years usually receive conventional chemotherapy with no transplantation. Yet, MM is highly heterogeneous, and age can no longer be the only criterion to select treatment strategy. Recently, a geriatric assessment has emerged as a valid tool to better characterize elderly patients and evaluate their frailty status. A frailty score has also been introduced by the International Myeloma Working Group, which allows a better stratification of patients into fit, intermediate, or frail categories, and consequently a more appropriate choice of therapy. A useful IT application program has been created to help clinicians quickly assess a patient’s frailty status, and further validation of the IMWG frailty score in clinical trials is necessary. Generally, fit patients can safely receive full-dose regimens, while gentler approaches with two-drug combinations and appropriate dose reductions are recommended for frail patients. Indeed, in frail patients, the aim of therapy should be controlling symptoms, maintaining an independence status and quality of life. Therefore, the achievement of a stable disease without myeloma-related symptoms related is an acceptable goal.