Get the latest public health information from CDC: https://www.coronavirus.gov. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. A prospective, multicenter, 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 (VP) in elderly untreated patients with multiple myeloma older than 65 years [abstract]. CAR T Cell Meeting 2019 | CAR T in multiple myeloma: when to use CAR T, On February 14, 2019, Professor Hermann Einsele, University Hospital Würzburg, Germany, presented at the 1st European CAR T Cell Meeting in Paris, France. 2001;113:1020-34. 1. Interested in becoming a supporter? 11. The incidence of any grade 3/4 adverse events was 52% in the high-dose dexamethasone arm, compared with 35% in the low-dose dexamethasone arm (P=.0001). 2009;360:2645-54. Incorporating high-dose melphalan followed by ASCT in a novel, agent-based, frontline strategy significantly improved PFS and OS, although the OS benefit was inconsistent across the trials.48-53, Historically, the age cutoff adopted to determine ASCT eligibility in clinical trials was 65 years. Infection prophylaxis is crucial when corticosteroids are used: fluconazole, trimethoprim-sulfamethoxazole, and acyclovir. 43. Although younger patients certainly have better outcomes with AHSCT,1  high-dose therapy does have a place in the management of selected older persons.2,3  Age has less impact on event-free survival (EFS) after AHSCT than on overall survival (OS),1  suggesting that older patients may benefit as much from high-dose therapy as younger. DOI: 10.1200/EDBK_239067 American Society of Clinical Oncology Educational Book How to manage elderly patients with multiple myeloma, based on an educational presentation at IMW 2019. Similarly, in the HOVON studies, we found an approximately 80%–90% rate of grades 3 and 4 toxicity in patients age 80 or older versus a rate of approximately 65%–85% in patients younger than age 80. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Life expectancy is shorter for octogenarians, but other relevant factors among individuals being treated for MM could include higher levels of toxicity induced during first-line treatment and more comorbidities that preclude subsequent treatment at relapse. In the HOVON 126, non–transplantation eligible patients were treated with nine induction cycles of ixazomib/thalidomide/dexamethasone followed by a random assignment to maintenance with placebo or ixazomib.43 Of the population, 11 (8%) of 143 patients were older than age 80. The approach to an elderly patient with relapsed disease needs to be individualized and depends on several factors (Table 4).5,18, Factors determining approach to relapsed disease. However, since the availability of new and more active drugs, several groups have compared in several phase III trials t … I = Immediate Family Member, Inst = My Institution. The observation of decreased neuropathy with weekly dosing has now been confirmed.17,24,25  In one of the studies,17  bortezomib-melphalan-prednisone (VMP) induction followed by maintenance with bortezomib-thalidomide (VT) or bortezomib-prednisone (VP) was compared with bortezomib-thalidomide-prednisone (VTP) induction followed by VT or VP as maintenance. As a consequence of these studies, the regimen MPT is now considered a new standard of care and it has been approved by the European Medicines Agency (EMEA) for the treatment of patients older than 65 years with newly diagnosed MM. Epub 2010 July 13. Outcome of elderly patients 70 years and older with newly diagnosed myeloma in the ECOG randomized trial of lenalidomide/high-dose dexamethasone versus lenalidomide/low-dose dexamethasone (abstract). Please For most patients, more than or equal to 50% of the duration of their disease will fall in the salvage therapy phase (Figure 1).

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