Introduction
Multiple myeloma is a type of cancer that affects the white blood cells. Myeloma cells are also known as cancerous plasma cells, which produce abnormal antibodies that affect healthy blood cells and result in multiple myeloma. Multiple myeloma usually affects elderly people. According to the American Cancer Society, people around 65 years of age or older are commonly diagnosed with multiple myeloma. Treatment of MM depends upon the patient's condition and factors that influence MM in older people. This article will explain the symptoms, causes, treatment, and effects on elderly people.
What Are Treatment Considerations for Older Patients with Multiple Myeloma?
Every individual faces different kinds of symptoms and results in the case of Multiple myeloma.
Research and studies show that OS PFS-defined as the period a person with MM lives without their disease progressing-considerably decreases with each decade of life. Age-related factors also influence the prognosis of multiple myeloma. People and their doctors will consider all the influencing factors while planning the treatment.
1. Frailty of Multiple: Frailty is known as the loss of physical function, which results in many changes in health. Aging is the most common cause of multiple myeloma. Most patients with myeloma are usually frail when they are diagnosed. The doctor will be able to evaluate frailty on the basis of:
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General health includes mobility and balance of the body.
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Patients' mental health, their ability to exercise, independence, and ability to perform daily routine work.
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Patients who are frail are not eligible for some particular treatments. In this case the doctor will advise the required treatment.
2. Comorbidities: Comorbidity is known as a concomitant medical condition, and it commonly occurs with multiple myeloma. 50% of the patients with multiple myeloma had at least one comorbidity or more. Patients with more comorbidities have low survival rates. Comorbidities are commonly seen in old-aged patients. Patients with MM have the following comorbidities:
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Diabetes, diabetes mellitus, cardiovascular disease.
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Previous peripheral neuropathy and thrombosis.
The doctor will take note of all the present comorbidities while planning the treatment of multiple myeloma because it is possible that certain medicines may aggravate the comorbid conditions.
3. Additional Factors: Patients and their healthcare team should note down the following points while planning the treatment of MM:
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How advanced is the MM?
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How fast is the MM growing and progressing?
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Whether the patient has extramedullary disease.
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If MM is in an organ other than the bone marrow.
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Whether the patient is affected by renal disease associated with multiple myelitis
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Whether or not the patients have specific genetic changes.
Personal qualities and lifestyle also affect the condition.
What Are the Available Treatment Options for Older Adults with Multiple Myeloma?
An older patient's body fitness can affect the treatment plan of MM. A complete cure of the MM is the requirement of the treatment. Symptoms of MM can be minimized, and the patient can have a better quality of life. Multiple myeloma treatment involves multiple stages and approaches. Following are the treatment stages of MM:
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Treatment Induction: Many medicines are involved in the treatment of multiple myeloma in the initial phase. Corticosteroids are helpful in reducing inflammation, and it is also a source of anti-myeloma activities.
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Targeted Treatment: Targeted treatment inhibits the progression of proteins that are associated with developing myeloma cells.
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Immunotherapy: Immunomodulatory includes medicine that increases the immunity and immune response to multiple myeloma. Following are the common medications that can be used in the initial treatments of multiple myeloma:
Targeted therapy medicines include Lenalidomide, an immunomodulatory drug, Dexamethasone, a corticosteroid, Bortezomib, or Daratumumab. These are some of the combination drugs among many medicines for MM. The doctor will consider the patient's fitness, overall health, and side effects while choosing a medicine for MM treatment.
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Autologous Stem Cell Transplant: ASCT is a very demanding treatment. Many elderly patients are not eligible for ASCT. Patients who are not frail are commonly considered for ASCT. A healthcare team will evaluate the overall health condition and the degree of frailty. ASCT helps in improving the PFS of the patient. PFS is usually increased in people aged between 65 to 69.
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Maintenance Therapy: If a patient does not go under ASCT, it is possible that the recurrence of MM occurs. So a maintenance therapy is required to prevent this recurrence. Generally, maintenance therapy involves the long-term use of one or several drugs. Most of the studies demonstrated that Lenalidomide-based regimens were superior according to PFS and OS data.
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Supportive Treatment: The main aim of supportive therapy is to decrease symptoms of MM and improve the quality of life. Some of the supportive treatments for multiple myeloma include:
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Bisphosphonates or radiation therapy can be used to increase the counts of red blood cells, which may reduce the effects of anemia caused by MM.
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IVIG or intravenous immunoglobulin to treat infections.
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Plasmapheresis may reduce the abnormal antibody levels in your blood associated with MM.
How Is the Prognosis of Multiple Myeloma In Older People?
The National Cancer Institute SEER Database releases a report that the 5-year relative survival rate for persons with MM is 59.8 % for all ages. This report is based upon the number of patients with MM in comparison to those who do not have MM. However, the prognosis of patients with MM tends to decrease with age.
Conclusion
Multiple myeloma is generally diagnosed in elderly people. Many health problems emerge with MM. It is hard to recognize the health problems in the early phases because patients are either confused or unaware of the symptoms. However, comorbidities and frailty are two common considerations while diagnosing MM. If a patient is physically fit and able to do their daily routine task, then there is a higher chance of a good prognosis and survival is present. It is important to have a consultation at a very early stage with the doctor so the doctor can diagnose the patient and prepare a treatment plan accordingly. Early diagnosis always leads to a good prognosis. A team of healthcare professionals will assist individuals who have just received an MM diagnosis.
