TY - JOUR
T1 - First-line treatment of multiple myeloma in elderly patients
T2 - The GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) multiple myeloma working party perspective
AU - Musto, Pellegrino
AU - D'Auria, Fiorella
AU - Pietrantuono, Giuseppe
AU - Baldini, Luca
AU - Bringhen, Sara
AU - Caravita, Tommaso
AU - Di Raimondo, Francesco
AU - Morabito, Fortunato
AU - Offidani, Massimo
AU - Petrucci, Maria Teresa
AU - Tosi, Patrizia
AU - Gay, Francesca
AU - Cavo, Michele
AU - Boccadoro, Mario
AU - Palumbo, Antonio
PY - 2009
Y1 - 2009
N2 - Multiple myeloma (MM) is a neoplastic disorder affecting elderly people. The treatment for all patients with MM was, for about 40 years, based on the combination of melphalan plus prednisone, with a very low rate of complete remissions and a survival that remained unacceptably low (about 36 months). Diverse factors, including comorbidity, performance status, decreased physiologic reserve, and potential undertreatment, contribute to these poor outcomes. Recently, however, the reduced treatment-related morbidity and mortality associated with autologous stem-cell transplantation and the availability of effective new drugs with acceptable toxicity, such as thalidomide, lenalidomide and bortezomib, have greatly modified the traditional treatment paradigms in older patients with MM, challenging, in some cases, the definition of elderly and rapidly transforming the traditional palliative treatments to a new global therapeutic strategy, with the final objective of significantly improving the quality and the duration of life for elderly people with this disease. In this review, we report updated data for the front-line treatment of MM in the elderly population, examining the role of new drugs combined with melphalan or their incorporation within more complex combinations, including other so-called conventional drugs such as (pegylated)-doxorubicin, cyclophosphamide, and dexamethasone. We also assess the role of autologous and allogeneic stem-cell transplantation with adjusted conditioning regimens in selected elderly patients.
AB - Multiple myeloma (MM) is a neoplastic disorder affecting elderly people. The treatment for all patients with MM was, for about 40 years, based on the combination of melphalan plus prednisone, with a very low rate of complete remissions and a survival that remained unacceptably low (about 36 months). Diverse factors, including comorbidity, performance status, decreased physiologic reserve, and potential undertreatment, contribute to these poor outcomes. Recently, however, the reduced treatment-related morbidity and mortality associated with autologous stem-cell transplantation and the availability of effective new drugs with acceptable toxicity, such as thalidomide, lenalidomide and bortezomib, have greatly modified the traditional treatment paradigms in older patients with MM, challenging, in some cases, the definition of elderly and rapidly transforming the traditional palliative treatments to a new global therapeutic strategy, with the final objective of significantly improving the quality and the duration of life for elderly people with this disease. In this review, we report updated data for the front-line treatment of MM in the elderly population, examining the role of new drugs combined with melphalan or their incorporation within more complex combinations, including other so-called conventional drugs such as (pegylated)-doxorubicin, cyclophosphamide, and dexamethasone. We also assess the role of autologous and allogeneic stem-cell transplantation with adjusted conditioning regimens in selected elderly patients.
KW - Autologous transplantation
KW - Bendamustine
KW - Bortezomib
KW - Cyclophosphamide
KW - Dexamethasone
KW - Doxorubicin
KW - Elderly
KW - Lenalidomide
KW - Myeloma
KW - Reduced-intensity allogeneic transplantation
KW - Thalidomide
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U2 - 10.2174/138945009789577936
DO - 10.2174/138945009789577936
M3 - Article
C2 - 19663768
AN - SCOPUS:70450209034
SN - 1389-4501
VL - 10
SP - 906
EP - 922
JO - Current Drug Targets
JF - Current Drug Targets
IS - 10
ER -