Stem cell treatment for multiple myeloma

10,11 Assessment of Frailty in MMДЄssociation of a patientвЂ™s ECOG performance status (PS) with survival and outcomes has been documented in patients with cancer. However, identifying those patients who are TE remains important, given the progression-free survival (PFS) benefit obtained from an upfront autologous stem cell transplant (ASCT) approach. 8,9 As discussed in greater detail below, there is increasing overlap between induction regimens in transplant-eligible (TE) and TI groups. 5-7 However, with advancing age and/or increasing comorbidities, the benefit-to-risk ratio may change, and thus a multidisciplinary approach, including geriatric evaluation, is recommended to optimally determine transplant candidacy. Multiple groups have documented the safety and efficacy of transplant in the older population.

It is important to note that transplant eligibility can be in the eye of the beholder there is no strict age cut-off. In this review, we discuss treatment options for newly diagnosed (ND) and relapsed/refractory (R/R) MM in the context of the generally older and/or frail transplant-ineligible (TI) patient population. When making those treatment decisions, there is no one-size-fits-all approach therefore, the patientвЂ™s fitness can play a significant role in determining the appropriate therapy. The goal is to give each patient the best chance of achieving the best possible response, while not conferring excessive toxicity with treatment that is not curative. 4 Whether achievement of MRD negativity translates to being able to safely discontinue therapy without increasing risk of relapse remains to be determined.

3 Nonetheless, the depth of response to treatment-as assessed by minimal residual disease (MRD)-has been shown to correlate with survival, even in TI patients. The median age at diagnosis is 69 years, 2 and despite the many strides made in the treatment of MM and discovery of agents with novel mechanisms, MM is still considered an incurable disease. Multiple myeloma (MM) is an embodiment of this challenge. 1 With the multitude of treatment options available for many diseases, this makes it more important than ever for physicians to make treatment decisions that take into account the nature of the disease, the treatment toxicity, and a patientвЂ™s fitness and comorbidity profile. Between 19, US life expectancy increased from 69.9 to 78.9 years.

The significant developments in medicine have contributed to a globally aging population. We describe the patient-specific considerations that factor into treatment decisions as well as provide some guidance about management. In this review, we discuss assessment of frailty and focus on treatment options in both the newly diagnosed and relapsed/refractory settings for TI patients. Likewise, results obtained from randomized relapsed/refractory studies also may not be applicable to this generally older and frailer patient population. The individuals enrolled in clinical trials for newly diagnosed TI patients, or those with no planned transplant, may not always be reflective of real-world patients, with respect to age, comorbidities, or frailty status. While significant advances have been made in the treatment of multiple myeloma, the management of the transplant-ineligible (TI) patient population remains challenging.

Stem cell treatment for multiple myeloma