Multiple myeloma is a type of cancer affecting plasma cells. Most people who receive a diagnosis of this cancer are older adults. A variety of factors can affect treatment decisions in older adults with multiple myeloma.
Multiple myeloma (MM) is a cancer that affects plasma cells, a type of white blood cells. Cancerous plasma cells, called myeloma cells, crowd out healthy blood cells and produce abnormal antibodies, leading to the symptoms of MM.
Doctors most often diagnose MM in older adults. According to the
Older adults with MM have certain considerations that can affect the type of treatment doctors recommend. Keep reading to learn more about how MM is treated in older adults.
Here’s more in-depth information about multiple myeloma.
Age is an important factor that affects outcomes in people with MM. For example, a
Other age-related factors also influence your outlook for MM. You and your doctors will need to consider these when planning your treatment.
Frailty
Frailty is a reduction in function that makes you more vulnerable to dramatic changes in health. Its prevalence
Healthcare professionals can assess frailty by evaluating factors such as your:
- overall health
- movement and balance
- physical activity levels
- mental state
- independence status
- ability to do basic daily activities
People who are considered frail may not be able to tolerate certain types of MM treatment. Therefore, doctors may recommend other treatments instead.
Comorbidities
A comorbidity is a health condition that is present at the same time as MM. A
The prevalence of comorbidities tends to increase with age. Some types of comorbidities that are
When making MM treatment recommendations, your healthcare team will need to consider your comorbidities, their severity, and whether certain treatments could worsen them.
Other factors
Additional factors you and your healthcare team need to consider when planning MM treatment include:
- the stage of your MM
- how rapidly your MM is growing and spreading
- whether you have extramedullary disease (MM that affects areas of your body outside of your bone marrow)
- whether you have kidney disease related to MM
- whether you have certain genetic changes
Personal factors are also very important. These include your personal preference for treatment as well as considerations for how different treatments could affect your quality of life.
Healthcare team for multiple myeloma treatment
If you’re receive a diagnosis of MM, your healthcare team will include several professionals, such as:
- a hematologist (a doctor who specializes in treating conditions affecting the blood)
- a medical oncologist (a doctor who specializes in treating cancer)
- a radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
- a bone marrow transplant specialist
- a radiologist (a doctor who specializes in interpreting medical images, such as X-rays and MRI scans)
- a pathologist (a doctor who specializes in analyzing tissue samples under a microscope)
- an orthopedic surgeon
- your primary care physician
- nurses and nurse practitioners
- mental health professionals
- pharmacists
- dietitians or nutritionists
- social workers
Treatment goals for MM in older adults
Meanwhile, for someone who is frail, the goal may be to reduce symptoms while improving quality of life and independence.
There can be several stages of MM treatment. Let’s explore each stage and how it relates to older adults.
Induction therapy
First-line treatment for MM can often involve several types of drugs, including:
- targeted therapy, which inhibits specific factors associated with myeloma cells
- immunotherapy with immunomodulatory drugs, which helps your immune system respond to MM
- corticosteroid therapy, which reduces inflammation and has anti-myeloma activity
Some of the
- either bortezomib (Velcade) or daratumumab (Darzalex), which are targeted therapy drugs
- lenalidomide (Revlimid), an immunomodulatory drug
- dexamethasone, a corticosteroid
This is just
Autologous stem cell transplant
In general, an autologous stem cell transplant (ASCT) is considered the
Generally, if you are not frail, you may be eligible for an ASCT. Your healthcare team will assess your health and frailty to decide whether you’re eligible.
In a
Maintenance therapy
Maintenance therapy is treatment that can help prevent MM from returning and may be used in some people,
Maintenance therapy typically involves long-term treatment with a single drug or a drug combination.
Supportive treatments
Supportive treatments are aimed at relieving symptoms and improving your quality of life. Some supportive treatments that may be used for MM are:
- bisphosphonates or radiation therapy for MM-related bone disease
- medications to help increase red blood cell counts, reducing the effects of MM-related anemia
- intravenous immunoglobulin (IVIG) to help with infections
- plasmapheresis to reduce the levels of MM-related abnormal antibodies in your blood
According to the
Generally, the outlook for MM becomes less favorable with increasing age. For example, the table below shows the median PFS and OS data from a
Progression-free survival (PFS) and overall survival (OS) after diagnosis and by age group for people with MM
| Age | PFS | OS |
|---|---|---|
| less than 65 years | 37.7 months | 95.9 months |
| 65–74 years | 31.6 months | 68.6 months |
| 75–84 years | 21 months | 42.9 months |
| 85 years and older | 16.3 months | 27.3 months |
However, remember that every person with MM is different. Statistics typically do not account for individual factors or recent advances in treatment.
MM most commonly occurs in older adults. Factors such as frailty and comorbidities can affect the treatment choices for this population.
The treatment for MM typically involves one or more drugs. An ASCT may also be used for more fit people and can help improve survival.
If you’ve recently received an MM diagnosis, be sure to talk with your healthcare team about your individual outlook and treatment recommendations. They can give you a better idea of what to expect.