Treatment Options for Multiple Myeloma in Elderly Patients

Understanding Multiple Myeloma in the Aging Population

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, particularly those over the age of 65. As the body ages, treatment decisions must balance effectiveness with patient safety, especially considering potential comorbidities and reduced tolerance to aggressive therapies.

Primary Treatment Approaches: Chemotherapy vs. Stem Cell Transplantation

Chemotherapy as the Preferred Option for Older Adults

For elderly patients, chemotherapy remains the cornerstone of multiple myeloma treatment. Unlike younger individuals, older adults often face higher risks when undergoing intensive procedures such as autologous hematopoietic stem cell transplantation (ASCT). Due to decreased organ function and increased vulnerability to complications, ASCT is generally not recommended for patients over 65 unless they are exceptionally fit and have strong overall health.

As a result, oncologists typically favor chemotherapy regimens tailored to the individual's physical condition, kidney function, and disease progression. These regimens aim to control tumor growth, relieve symptoms, and extend survival while maintaining quality of life.

Advanced Drug Therapies Revolutionizing Treatment

Modern treatment protocols increasingly rely on targeted agents that offer high efficacy with more manageable side effects. Among the most widely used are proteasome inhibitors like bortezomib and immunomodulatory drugs such as lenalidomide. These medications disrupt the survival mechanisms of myeloma cells and enhance immune system activity against cancer.

In recent years, a significant advancement has been the introduction of CD38 monoclonal antibodies, now available in many regions including China. Drugs like daratumumab target CD38 proteins expressed on myeloma cells, triggering their destruction through immune-mediated pathways. This class of therapy has shown promising results in both newly diagnosed and relapsed cases among elderly populations.

Combination Therapies for Enhanced Outcomes

To maximize therapeutic benefits, hematologists often design combination regimens that integrate two or more of these powerful agents. For example, a triple therapy combining bortezomib, lenalidomide, and dexamethasone (VRd) is frequently used in eligible older patients. When appropriate, CD38 antibodies may be added to create quadruplet regimens, further improving response rates and depth of remission.

These combinations are carefully adjusted based on the patient's age, performance status, and laboratory parameters. The goal is to achieve rapid disease control while minimizing toxicity and preserving daily functioning.

Personalized Care Led by Hematology Specialists

Treatment planning should always be guided by a qualified hematologist or oncology specialist. Each patient presents a unique clinical picture, requiring an individualized strategy that considers not only the biology of the disease but also personal preferences and long-term care goals. Regular monitoring, dose modifications, and supportive care—including management of anemia, bone lesions, and infections—are integral parts of successful treatment.

In conclusion, while multiple myeloma poses significant challenges in elderly patients, advances in drug therapy have dramatically improved outcomes. With personalized chemotherapy regimens incorporating novel agents like bortezomib, lenalidomide, and CD38-targeted antibodies, many seniors can now experience prolonged remissions and a better quality of life.