Lancet Oncol. Rosinol L, Blade J, Esteve J, et al. Waage A, Gimsing P, Fayers P, et al. J Clin Oncol. 2012 Feb;156(3):326-33. doi: 10.1111/j.1365-2141.2011.08949.x. The International Myeloma Working Group Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders. [44] However, using the same regimen, the IFM failed to confirm this finding. To date, five randomized studies have been published comparing MP with MP plus thalidomide (MPT) as primary treatment in elderly patients with MM. The difference between SMM and MM is that patients with SMM must have no evidence of related organ or tissue impairment (end-organ damage). Palumbo A, Triolo S, Argentino C, et al. Autologous stem cell transplantation is feasible in selected fit patients over 65 years of age, and its results are improved by the addition of novel agents before and after high-dose therapy. J Clin Oncol. Cesana C, Klersy C, Barbarano L, et al. For instance, bortezomib might be preferred in a patient with translocation (4;14), since it has been shown that even a short treatment may at least partially overcome the poor prognosis associated with this cytogenetic abnormality. A prospective, randomized trial of bortezomib/melphalan/prednisone (VMP) versus bortezomib/thalidomide/prednisone (VTP) as induction therapy followed by maintenance treatment with bortezomib/thalidomide (VT) versus bortezomib/prednisone in elderly untreated patients with multiple myeloma (abstract 3). Name must be less than 100 characters

2008;28:1599-16052. [14,39] Data involving lenalidomide are less clear.The key to treating elderly patients is to actually evaluate the efficacy/toxicity ratio and to reduce the toxicity of the regimens. Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering myeloma. Achievement of complete remission is a strong prognostic factor in 895 elderly myeloma patients treated with melphalan-prednisone based regimens: results of 3 multicenter Italian trials (abstract). Preliminary results of a Spanish randomized trial have showed that induction treatment with lenalidomide-dexamethasone followed by lenalidomide maintenance therapy significantly delays the risk of progression compared with no treatment. Multiple myeloma, also known as Kahler’s disease, is a type of blood cancer.

Phase 3 study to determine the efficacy and safety of lenalidomide combined with melphalan and prednisone in patients ≥ 65 years with newly diagnosed myeloma (abstract).

doi: 10.1182/asheducation-2009.1.566. [3] However, ASCT is feasible in patients older than 65 years, at least in selected patients with good performance status and no severe comorbidities. 2008;11:4039-47.3. 2014 Apr;89(4):355-62. doi: 10.1002/ajh.23641. For example, in the Nordic trial, the median patient age was 78 years, and the proportion of patients with an Eastern Cooperative Oncology Group (ECOG) performance status higher than 2 was 30%. 2007;356:2582-90.27. Bortezomib, melphalan, prednisone and thalidomide (VMPT) followed by maintenance with bortezomib thalidomide (VT) for initial treatment of elderly multiple myeloma patients (abstract 8013). Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. The objective of these improved treatment regimens should be to achieve complete response, as in younger patients. 2007;307:1209-1218.10. 1995;13:251-6.33. 2007;25:4459-65.17.

Kyle RA, Rernstein ED, Therneau TM, et al. [5]The introduction of immunomodulatory drugs (the “IMiDs”: thalidomide and lenalidomide) and of proteasome-inhibitors (bortezomib) has dramatically changed the management of MM in both younger and elderly patients. One might speculate that higher doses of melphalan (0.25 mg/kg/d for 4 days every 6 weeks) and thalidomide (200 mg/d for 1 week, and up to 400 mg/d) and inclusion of older and more frail patients were the reason that a better response rate did not translate into a longer PFS in the MPT arm.