Treatment Options for Multiple Myeloma in Elderly Patients

Multiple myeloma is a type of blood cancer that primarily affects plasma cells in the bone marrow. While it can occur at any age, it is most commonly diagnosed in older adults. As such, treatment strategies must be carefully tailored to accommodate the unique health challenges associated with aging. The two primary treatment approaches for multiple myeloma are chemotherapy and autologous hematopoietic stem cell transplantation (ASCT). However, due to increased risks related to age and comorbidities, ASCT is generally not recommended for elderly patients—especially those over the age of 65.

Why Chemotherapy Is Preferred for Older Adults

For seniors diagnosed with multiple myeloma, chemotherapy remains the cornerstone of treatment. Unlike more aggressive therapies such as stem cell transplants, which require high-dose conditioning regimens, chemotherapy offers a safer and more manageable approach. It helps control disease progression, alleviate symptoms, and improve overall quality of life without placing excessive strain on the body.

Common Chemotherapy Regimens Used Today

Several effective drug combinations are currently used in clinical practice. Among the most widely adopted are regimens that include proteasome inhibitors like bortezomib and immunomodulatory drugs such as lenalidomide. These agents work by targeting myeloma cells through different mechanisms—bortezomib disrupts protein degradation in cancer cells, while lenalidomide enhances immune system activity against malignant plasma cells.

The Role of Newer Therapies: CD38 Monoclonal Antibodies

In recent years, the introduction of CD38 monoclonal antibodies, now available in domestic markets, has significantly expanded treatment options for elderly patients. Drugs like daratumumab target the CD38 protein found on the surface of myeloma cells, marking them for destruction by the immune system. When combined with traditional chemotherapy agents, these biologics have demonstrated improved response rates and longer progression-free survival, even in frail or older populations.

Personalized Treatment Plans Are Key

Because each patient's condition, overall health status, and tolerance to therapy vary, treatment decisions should always be made in consultation with a hematology specialist. Physicians evaluate factors such as kidney function, performance status, genetic markers, and existing medical conditions before recommending a specific regimen. Combination therapies are often customized to balance efficacy with safety, ensuring optimal outcomes while minimizing side effects.

Looking Ahead: Managing Myeloma as a Chronic Condition

With advances in targeted therapies and supportive care, multiple myeloma is increasingly being managed as a chronic illness rather than an acutely terminal one—especially among older adults. Ongoing monitoring, timely adjustments to treatment, and a focus on maintaining daily functioning allow many elderly patients to live longer, more comfortable lives after diagnosis.