What should be considered to provide optimal treatment 
for vulnerable elderly myeloma patients

Abstract

In recent years, the overall survival of multiple myeloma patients has extended by the improvement of the treatment including novel agents, but such extension is not enough for the elderly patients. In this report, I discuss what should be considered to provide optimal treatment of vulnerable elderly myeloma patients. Twenty six percent of the newly diagnosed patients are aged 65–74 years old, 37% are more than 75 years old, so it is apparent that this disease is for elderly people. Elderly people are various than younger people and a gap exists between chronological age and biological age. European Myeloma Network proposed how to choose therapy and drug dose considering vulnerability, comorbidity, disability and frailty. Overall survival is extended even in the elderly patients who achieved CR by the therapy incorporating novel agents. However, appropriate dose reduction should be taken because of reduced organs function. The QOL score of myeloma patients before treatment is quite low, and the score is improved by chemotherapy. But attention is necessary because QOL score temporarily turns worse by a sort of novel agents.