Multiple Myeloma in Older Adults

Multiple myeloma is a disease of older adults, with two-thirds of patients aged ≥ 65 years and having varying comorbidities, functional status, and cognitive status. Patients ≥ 65 are usually considered ineligible for transplant. The introduction of novel agents, including immunomodulatory drugs such as lenalidomide and proteasome inhibitors such as bortezomib and carfilzomib, has improved treatment tolerance and resulted in improved outcomes for older patients. We present an individualized approach for older patients, “staging” patient age using Comprehensive Geriatric Assessment (CGA) to stratify into fit, unfit and frail groups to guide treatment decisions, including whether or not to transplant, use two-drug versus three-drug combinations, or use reduced-intensity regimens.