Multiple myeloma in elderly

Multiple myeloma is a type of cancer that affects plasma cells, a type of white blood cell found in the bone marrow.

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It primarily affects older adults, with the median age at diagnosis being around 69 years old. Here’s an overview of multiple myeloma in elderly patients:

**1. Presentation:**

• Multiple myeloma can present with a variety of symptoms, including bone pain (especially in the back, ribs, and hips), weakness, fatigue, recurrent infections, anemia, kidney dysfunction, hypercalcemia, and neurological symptoms (e.g., numbness, weakness, tingling).

**2. Diagnosis:**

   – Diagnosis of multiple myeloma involves a combination of clinical evaluation, laboratory tests, imaging studies, and bone marrow biopsy.

   – Laboratory tests typically show abnormalities such as monoclonal gammopathy (elevated levels of monoclonal proteins or M-proteins), elevated serum or urine protein levels, and abnormalities in blood counts (e.g., anemia, thrombocytopenia, leukopenia).

   – Imaging studies such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans may be used to evaluate bone lesions and assess the extent of disease involvement.

   – Bone marrow biopsy and aspiration are performed to examine the bone marrow for abnormal plasma cells and assess the percentage of plasma cells present (plasma cell infiltration).

**3. Treatment:**

   – Treatment of multiple myeloma in elderly patients is tailored based on factors such as age, overall health, disease characteristics, and treatment goals.

   – The mainstays of treatment include chemotherapy, immunomodulatory drugs (e.g., lenalidomide, pomalidomide), proteasome inhibitors (e.g., bortezomib, carfilzomib), corticosteroids (e.g., dexamethasone), and monoclonal antibodies (e.g., daratumumab, elotuzumab).

   – Autologous stem cell transplantation (ASCT) may be considered for eligible patients who are fit enough to undergo the procedure and have adequate organ function.

   – Supportive care measures, including bisphosphonates to reduce the risk of skeletal-related events (e.g., fractures, spinal cord compression), management of anemia and other complications, and supportive therapies (e.g., pain management, antibiotics for infections), are important components of treatment.

**4. Prognosis:**

   – The prognosis of multiple myeloma in elderly patients varies depending on factors such as age, overall health, stage of disease, response to treatment, and presence of adverse cytogenetic abnormalities.

   – With advancements in treatment options, including novel targeted therapies and immunotherapies, survival outcomes for elderly patients with multiple myeloma have improved in recent years.

   – However, multiple myeloma remains an incurable disease, and the goal of treatment is typically to control the disease, prolong survival, and improve quality of life.

**5. Supportive Care:**

   – Supportive care plays a critical role in the management of elderly patients with multiple myeloma, focusing on symptom management, pain control, maintenance of nutritional status, management of comorbidities, and psychosocial support.

   – Palliative care and hospice services may be incorporated into the care plan to address end-of-life care needs and provide holistic support for patients and their families.

Overall, the management of multiple myeloma in elderly patients requires a multidisciplinary approach, with close collaboration between hematologists/oncologists, geriatricians, nurses, pharmacists, and supportive care providers to optimize treatment outcomes and enhance the quality of life for patients affected by this challenging disease.