Multiple myeloma: Current and future management in the aging population

The increasing lifespan of the world population and the novel therapeutic combinations for the treatment of multiple myeloma (MM), which are more efficacious and safer, make the question of how to manage the older patient with MM increasingly relevant. Clinical trial data come mostly from subgroup analysis, as no clinical trials have been designed for elderly patients with MM, particularly the octogenarian population. Age has been traditionally used as a surrogate marker of physiological decline but does not accurately reflect frailty on its own. Validated frailty assessment tools that accurately and sensitively risk-stratify older MM patients are needed. Such tools are being increasingly incorporated into clinical trial design. We should aim to use them to offer a tailored therapeutic approach to this heterogeneous subgroup of the MM population. Risk stratification based on disease-specific and patient-specific characteristics helps set the relevant outcome measures and therapeutic goals that will allow the right choice of treatment. The treatment goal for all patients should be to prolong survival and preserve quality of life. In the fit old MM patient, good responses can be achieved by carefully selecting candidates for autologous stem cell transplant and novel triplet or quadruplet combinations. At the other end of the spectrum, quality-of-life outcome measures and toxicity minimization with dose adaptation should be the focus.