What to know about treatment for multiple myeloma in the elderly

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Although a multiple myeloma diagnosis may feel overwhelming, various treatments are available to limit symptoms and improve quality of life. The best option for an individual depends on their disease and overall state of health.

Doctors may recommend one or more of the following treatments:

Chemotherapy

Chemotherapy drugs destroy cancer cells or control their growth. However, they can also affect healthy cells and cause significant side effects such as fatigue, weight loss, and hair loss.

In the past, chemo was a mainstay of multiple myeloma treatment. As newer therapies have emerged, chemo has become less popular, but doctors still may recommend it to some older individuals.

To minimize the risk of complications, doctors may adjust the dosage of chemotherapy drugs or use different drugs that are less toxic. They can also prescribe medications to help manage side effects such as nausea and fatigue.

Immunotherapy

Immunotherapy is a treatment that uses the body’s immune system to fight cancer. It either boosts the immune system’s ability to recognize and attack cancer cells or targets specific proteins in cancer cells.

Immunotherapy drugs have some advantages for older adults. They do not cause bone issues and are safer for individuals with weaker bodies.

Targeted therapy

Targeted drug treatments focus on specific proteins or genes in cancer cells. Because these treatments have specific targets, they do not significantly affect healthy cells, so people typically experience fewer side effects.

Examples of targeted drug agents include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro).

Stem cell transplantation

Stem cell transplantation is a procedure that involves replacing diseased or damaged bone marrow with healthy stem cells.

Autologous stem cell transplantation is a common treatment for multiple myeloma. It usually involves collecting a person’s stem cells and then giving the person high dose chemotherapy to wipe out the cancer cells in the body. This causes a very low blood count.

Healthcare professionals then infuse the collected stem cells back into the person’s body to grow back as noncancerous blood cells.

Individuals ages 65 and older have a higher risk of post-transplantation complications and prolonged hospitalizations. Therefore, doctors must carefully assess each individual when recommending treatment.

Corticosteroids

These medications regulate the immune system and control inflammation in the body.

They are also active against cancerous cells. Doctors may use them in combination with various other medications and therapies to increase treatment success rates.

Older adults with multiple myeloma often have age-related health concerns that may complicate treatment. For example, they are more likely to have preexisting medical conditions such as heart disease, diabetes, and kidney problems.

Physical weakness is also a concern for elderly individuals. This can affect a person’s ability to cope with the treatment regimens.

Additionally, older individuals may have reduced organ function, which can affect the metabolism and elimination of drugs. This can result in altered drug concentrations and increased toxicity.

Furthermore, bone health is a consideration. Multiple myeloma can weaken the bones, and some treatments can cause bone loss. Because older individuals are more likely to have osteoporosis or previous fractures, multiple myeloma can further increase the risk of bone-related complications.

The average age at diagnosis of multiple myeloma is 69 years. However, about 35% of people with multiple myeloma receive a diagnosis at age 75 or older, and 10% of those diagnoses occur at age 85 or older. As age increases, the outlook for multiple myeloma becomes less favorable.

However, the outlook is highly variable, and many factors can affect outcomes.

Rather than age, the two main factors affecting the outlook are the stage and biology of the disease.

The Revised International Staging System is a method doctors use to stage multiple myeloma. It considers these factors:

• the blood level of the protein beta-2 microglobulin
• the blood level of the protein albumin
• changes in the genetic material in cancer cells

In stage 1, the 5-year overall survival rate is 82%, which means that about 8 in 10 people live for at least 5 years after diagnosis. This rate drops to 62% at stage 2 and 40% at stage 3.

Furthermore, older adults often have additional health conditions, which can complicate treatment and contribute to a less favorable outlook.

Multiple myeloma can significantly affect a person’s physical, emotional, and social well-being.

In addition, coping with the diagnosis and treatment can be challenging, so individuals need access to support and resources.

The International Myeloma Foundation provides information and support groups for people with multiple myeloma.

These groups offer a safe and supportive environment where people can share their experiences, ask questions, and receive emotional support from others who are going through similar experiences.

If a person experiences any symptoms of multiple myeloma, they should contact a healthcare professional promptly. Early detection and treatment can improve outcomes and quality of life.

Symptoms to look out for include:

• fatigue
• weakness
• anemia
• shortness of breath
• frequent infections
• bone pain
• weight loss

If a person living with multiple myeloma experiences new or worsening symptoms, they should consult their healthcare team.

The treatment of multiple myeloma in older adults requires a personalized approach. Doctors must consider the individual’s age, existing medical conditions, and overall health when deciding on the best treatment approach.

A treatment regimen may include chemotherapy, targeted therapy, immunotherapy, corticosteroids, or stem cell transplantation.

However, various age-related factors may limit a person’s treatment options.