When it comes to older adults, early mortality is probably the highest—there is an early death within six months. Part of that has to do in relation to kidney failure, underlying comorbidities and a poor performance status. Older patients with myeloma can get better and do very well with targeted therapy.
Full Answer
What is the prognosis of multiple myeloma in the elderly?
Myeloma-related skeletal complications in the elderly can be severe and debilitating; a variety of treatment approaches may be combined in addition to disease modification. Importantly, SCC occurs in 5% of patients with myeloma and may be the presenting problem.
What is “end of life” for elderly myeloma patients?
“End of life” is now considered as the last 12 months of life59(National Institute for Health and Care Excellence), and for some elderly myeloma patients, this may be from the point of diagnosis. A holistic needs assessment is therefore a vital tool from the outset, allowing patients to openly convey their needs and wishes.
Is myeloma treatment based on advanced age at diagnosis appropriate?
Despite observed higher early mortality, improved relative survival rates in the very elderly suggests treatment should not be with-held based on advanced age at diagnosis. Myeloma is a disease of the elderly.
Is multiple myeloma a life-limiting factor?
Myeloma treatment prevents and reverses disease-related organ damage thereby improving quality of life. The higher relative survival rate in very elderly myeloma patients compared to younger cohorts suggests that myeloma is often not a life-limiting factor for the former and frailty-adapted treatment should be routinely offered to these patients.
How long can an 80 year old live with multiple myeloma?
The median overall survival for patients diagnosed at age 80 years or older was 13.4 months, with those patients receiving systemic treatment having a median overall survival of 21.4 months, compared with 6.4 months for those not receiving treatment.
How is multiple myeloma treated in the elderly?
Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently.
What is life expectancy after multiple myeloma diagnosis?
Multiple myeloma is an uncommon cancer of the blood. The median length of survival after diagnosis with multiple myeloma is 62 months for Stage I, 44 months for Stage II, and 29 months for Stage III. Life expectancy depends on many factors, including the person's age, health, kidney function, and more.
How common is multiple myeloma in elderly?
Multiple myeloma (MM) is a common disease among the elderly with a median age of 70 years at diagnosis and many patients diagnosed at ≥75 (~30%) and ≥85 years (~10%) [1, 2].
How do I know final stages of multiple myeloma?
Symptoms of Late-Stage Multiple MyelomaBeing sick to your stomach.Bone pain in your back or ribs.Bruising or bleeding easily.Feeling very tired.Fevers.Frequent infections that are hard to treat.Losing a lot of weight.Not feeling like eating.More items...•
What is the final stage of multiple myeloma?
In multiple myeloma cases, stage 3 is the terminal stage. This means it's the most advanced stage of this type of rare cancer. Doctors use the international staging system to determine the stage of the cancer. This system is based on the levels of serum beta-2 microglobulin and serum albumin.
How do you know when multiple myeloma is getting worse?
As active multiple myeloma gets worse, you'll likely feel sicker, with fatigue or bone pain. You may have anemia, bleeding problems, or a lot of infections. Other symptoms of advanced multiple myeloma include unusual fractures, shortness of breath, weakness, feeling very thirsty, and belly pain.
Is multiple myeloma curable 2021?
While there is no cure for multiple myeloma, the cancer can be managed successfully in many patients for years.
How fast does multiple myeloma progress?
How quickly multiple myeloma progresses can vary between people. An older 2007 study of 276 people found that there was a 10% risk of progression in people with early multiple myeloma per year for the first 5 years of illness.
How do you treat frail myeloma?
Alkylator-based regimens such as low-dose cyclophosphamide-prednisone, MP, or thalidomide may still play a role in frail patients relapsing after lenalidomide and bortezomib. Cyclophosphamide (50 mg every other day), melphalan (2 mg every other day), or thalidomide (50 mg every other day) may be used.
Are there stages of multiple myeloma?
In this system, there are three stages of myeloma: Stage I, Stage II, and Stage III. The stage depends on factors including: The amount of myeloma cells in the body. The amount of damage the myeloma cells have caused to the bone.
What is RVD Lite?
Modified lenalidomide, bortezomib, and dexamethasone (RVD-lite) is a highly effective and well tolerated treatment regimen among patients with multiple myeloma (MM) ineligible for transplant, according to a study published in the British Journal of Haematology.
Why is individualization important in myeloma?
Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects.
What is the goal of complete remission?
If significant toxicity is seen, obtaining good disease control while maintaining quality of life is reasonable. Prolongation of remission and survival are additional goals. Symptom control is achieved through effective disease-specific and supportive therapy.
Is bortezomib a good treatment for myeloma 9?
Bortezomib with or without corticosteroids has excellent activity in myeloma 9 and constitutes reasonable therapy at any stage of the disease. Single-agent bortezomib is superior to dexamethasone for relapsed disease. 34 However, it is common practice to combine bortezomib and corticosteroids from the beginning.
Is bortezomib more potent than thalidomide?
With the availability of lenalidomide and bortezomib—both more potent than thali domide —it is easy to overlook the important activity of thalidomide. A key characteristic thalidomide shares with corticosteroids is lack of myelosuppression. 8, 29 Single-agent thalidomide is a reasonable option in patients with relatively low-grade disease, especially if marrow function is compromised.
What happens to a patient's performance status as they progress?
In general, as the disease progresses and patients receive increasing amounts of therapy, performance status declines. This, coupled with advancing age, makes intensive therapy options more difficult to deliver later in the course of the disease.
Is lenalidomide effective in myeloma?
Lenalidomide combinations. The combination of MP and lenalidomide (MPL/MPR) is effective in myeloma. 26 However, lenalidomide and MP are myelosuppressive, and MPL can result in significant hematologic toxicity, especially in elderly patients.
Is myeloma considered an older person?
In myeloma, the term “elderly” is sometimes used synonymously with a person ineligible for high-dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT). This is not always true. Although younger patients certainly have better outcomes with AHSCT, 1 high-dose therapy does have a place in the management of selected older persons. 2, 3 Age has less impact on event-free survival (EFS) after AHSCT than on overall survival (OS), 1 suggesting that older patients may benefit as much from high-dose therapy as younger.