Frontline treatment of multiple myeloma in the elderly Volume 19, issue 1, Janvier-Février 2013


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Hôpital Saint-Antoine, Université Pierre-et-Marie-Curie, Paris, France

In recent years, considerable progress has been made in the treatment of multiple myeloma, with the introduction of novel drugs such as the proteasome inhibitors (bortezomib) and the immunomodulatory drugs (thalidomide and lenalidomide). Treatment of myeloma in the elderly can be challenging, since in addition to age, it is mandatory to take into account the physiological changes associated with aging, but also the issue of comorbidities and polymedications, which are quite common in elderly patients. Currently, two combinations are approved in France and Europe for first-line treatment in elderly myeloma, namely the combination called MPT (melphalan, prednisone and thalidomide) and the combination MPV (melphalan, prednisone and bortezomib). These two combinations have largely supplanted the classical combination MP (melphalan, prednisone). Currently new drugs and new combinations are emerging, but the optimization of dosing regimens within already approved combinations (e.g. dose, frequency, or mode of administration adjustment) might represent a powerful tool to wards significantly improving long-term outcome of elderly myeloma.