{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:35:12Z","timestamp":1793144112887,"version":"4.5.0"},"reference-count":104,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"39","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American Society of Clinical Oncology Educational Book"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p> Multiple myeloma (MM) is a disease of aging adults, and numerous therapeutic options are available for this growing demographic. MM treatment of older adults continues to evolve and includes novel combinations, new generations of targeted agents, immunotherapy, and increasing use of autologous stem cell transplantation (ASCT). Understanding age-related factors, independent of chronologic age itself, is an increasingly recognized factor in MM survivorship, especially in understudied populations, such as octogenarians. Octogenarians have inferior survival that cannot be explained by cytogenetic profiles alone. Incorporating assessments of geriatric factors can provide guidance on how to intensify or de-escalate therapeutic options. Functional status, using objective testing, is superior to traditional metrics of performance status and should be implemented to optimize the risk-benefit ratio of ASCT. ASCT is feasible and cost-effective, and chronologic age should not exclude ASCT eligibility. Upfront ASCT remains the standard of care, in the context of a sequential approach that includes pre-transplantation induction and post-transplantation maintenance. High-risk MM is classically defined by disease characteristics, yet shifting frameworks suggest that the high-risk designation could refer to any patient subgroup who is at risk for poorer outcomes\u2014beyond disease-focused outcomes to patient-focused outcomes. Defining the optimal treatment of subgroups of older patients with high-risk disease on the basis of chromosomal abnormalities is unexplored. Here, we review tools to assess individual health status, explore vulnerability in octogenarians with MM, address ASCT decision-making, and examine high-risk MM to understand factors that contribute to survival disparities for older adults with MM. <\/jats:p>","DOI":"10.1200\/edbk_239067","type":"journal-article","created":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T14:29:36Z","timestamp":1558103376000},"page":"500-518","source":"Crossref","is-referenced-by-count":48,"title":["Approach to the Older Adult With Multiple Myeloma"],"prefix":"10.1200","author":[{"given":"Roberto","family":"Mina","sequence":"first","affiliation":[{"name":"Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Bringhen","sequence":"additional","affiliation":[{"name":"Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya M.","family":"Wildes","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Zweegman","sequence":"additional","affiliation":[{"name":"Department of Hematology, Amsterdam UMC, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley E.","family":"Rosko","sequence":"additional","affiliation":[{"name":"Division of Hematology, The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"bibr2-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.4177"},{"key":"bibr3-EDBK_239067","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1002\/ajh.25117","volume":"93","author":"Rajkumar SV","year":"2018","journal-title":"Am J Hematol"},{"key":"bibr4-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.12.024"},{"key":"bibr5-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2016002493"},{"key":"bibr6-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2013.313"},{"key":"bibr7-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.46.3323"},{"key":"bibr8-EDBK_239067","volume":"130","author":"Orme J","year":"2017","journal-title":"Blood"},{"key":"bibr9-EDBK_239067","volume":"34","author":"Vogl DT","year":"2016","journal-title":"J Clin Oncol"},{"key":"bibr10-EDBK_239067","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1016\/j.jval.2018.04.022","volume":"21","author":"Wagner I","year":"2018","journal-title":"Value Health"},{"key":"bibr11-EDBK_239067","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1532-5415.1957.tb00055.x","volume":"5","author":"Weinberg M","year":"1957","journal-title":"J Am Geriatr Soc"},{"key":"bibr12-EDBK_239067","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/00075197-200201000-00004","volume":"5","author":"Devons CA","year":"2002","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"bibr13-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.8347"},{"key":"bibr14-EDBK_239067","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/j.1532-5415.2005.53312.x","volume":"53","author":"Rockwood K","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"bibr15-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)62167-9"},{"key":"bibr16-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-12-615187"},{"key":"bibr17-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/bcj.2011.34"},{"key":"bibr18-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.162693"},{"key":"bibr19-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2015.07.266"},{"key":"bibr20-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2015.03.003"},{"key":"bibr22-EDBK_239067","first-page":"jgs.15715","author":"Wildes TM","year":"2018","journal-title":"J Am Geriatr Soc"},{"key":"bibr23-EDBK_239067","first-page":"S1879-4068(18)3","author":"Rosko AE","year":"2018","journal-title":"J Geriatr Oncol"},{"key":"bibr24-EDBK_239067","volume":"2","author":"Mian HS","year":"2018","journal-title":"JCO Clin Cancer Inform"},{"key":"bibr25-EDBK_239067","first-page":"S1879-4068(18)3","author":"Murillo A","year":"2018","journal-title":"J Geriatr Oncol"},{"key":"bibr26-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2013.03.013"},{"key":"bibr27-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20059"},{"key":"bibr28-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.10.2954"},{"key":"bibr29-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2013.12.018"},{"key":"bibr30-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"bibr32-EDBK_239067","doi-asserted-by":"crossref","first-page":"e009584","DOI":"10.1136\/bmjopen-2015-009584","volume":"6","author":"V\u00e9lez R","year":"2016","journal-title":"BMJ Open"},{"key":"bibr33-EDBK_239067","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1093\/gerona\/glt162","volume":"69","author":"Lowsky DJ","year":"2014","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"bibr34-EDBK_239067","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1182\/blood-2018-99-116920","volume":"132","author":"Stege CAM","year":"2018","journal-title":"Blood"},{"key":"bibr35-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30348-6"},{"key":"bibr36-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1966"},{"key":"bibr37-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.1184"},{"key":"bibr38-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.66.7295"},{"key":"bibr39-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.26.0638"},{"key":"bibr40-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1714678"},{"key":"bibr41-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2016.36"},{"key":"bibr42-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-11-679415"},{"key":"bibr43-EDBK_239067","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1182\/blood-2018-99-111650","volume":"132","author":"Zweegman S","year":"2018","journal-title":"Blood"},{"key":"bibr44-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2012.075051"},{"key":"bibr45-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2018.07.003"},{"key":"bibr46-EDBK_239067","author":"Gavriatopoulou M","journal-title":"Leuk Lymphoma"},{"key":"bibr47-EDBK_239067","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.clml.2017.06.013","volume":"17","author":"Shah JJ","year":"2017","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"bibr48-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402888"},{"key":"bibr49-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00389-7"},{"key":"bibr50-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31594-X"},{"key":"bibr51-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Durie BG, Hoering A, Sexton R, et al. Longer term follow up of the randomized phase III Trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (pts) with previously untreated multiple myeloma without an intent for immediate autologous stem transplant. Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 1992.","DOI":"10.1182\/blood-2018-99-117003"},{"key":"bibr52-EDBK_239067","first-page":"401","volume":"130","author":"Cavo M","year":"2017","journal-title":"Blood"},{"key":"bibr53-EDBK_239067","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1182\/blood-2017-01-763219","volume":"130","author":"Cavo M","year":"2017","journal-title":"Blood"},{"key":"bibr54-EDBK_239067","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1182\/blood-2013-07-510941","volume":"122","author":"Morgan GJ","year":"2013","journal-title":"Blood"},{"key":"bibr55-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-09-568915"},{"key":"bibr56-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2014.255"},{"key":"bibr57-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx096"},{"key":"bibr58-EDBK_239067","doi-asserted-by":"crossref","first-page":"230","DOI":"10.6004\/jnccn.2017.0023","volume":"15","author":"Kumar SK","year":"2017","journal-title":"J Natl Compr Canc Netw"},{"key":"bibr59-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-02-0408"},{"key":"bibr60-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61537-2"},{"key":"bibr61-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-02-483073"},{"key":"bibr62-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.150334"},{"key":"bibr63-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.151860"},{"key":"bibr64-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Nadiminti K, Strouse C, Vikas P, et al.A single autologous stem cell transplant (ASCT) followed by two years of post-transplant therapy in recently diagnosed elderly multiple myeloma (MM) patients: safety and response results from the prospective phase II Trial (NCT01849783). Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 2153.","DOI":"10.1182\/blood-2018-99-118443"},{"key":"bibr65-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2011.606942"},{"key":"bibr66-EDBK_239067","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1093\/annonc\/mdt509","volume":"25","author":"Merz M","year":"2014","journal-title":"Ann Oncol"},{"key":"bibr67-EDBK_239067","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1159\/000357394","volume":"132","author":"Ozaki S","year":"2014","journal-title":"Acta Haematol"},{"key":"bibr68-EDBK_239067","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.bbmt.2017.03.012","volume":"23","author":"Sanchez L","year":"2017","journal-title":"Biol Blood Marrow Transplant"},{"key":"bibr69-EDBK_239067","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1080\/10428194.2016.1233542","volume":"58","author":"Stettler J","year":"2017","journal-title":"Leuk Lymphoma"},{"key":"bibr70-EDBK_239067","doi-asserted-by":"crossref","unstructured":". Belotti A, Ribolla R, Cancelli V, et al. The IMWG frailty score and age can be more effective than clinical judgement in the selection of elderly patients with newly diagnosed multiple myeloma who can benefit from an intensive treatment approach with high dose melphalan and autologous stem cell transplantation. Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 2151.","DOI":"10.1182\/blood-2018-99-113022"},{"key":"bibr71-EDBK_239067","author":"Ghilardi G","journal-title":"Bone Marrow Transplant"},{"key":"bibr72-EDBK_239067","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00277-018-3528-x","volume":"98","author":"Marini C","year":"2019","journal-title":"Ann Hematol"},{"key":"bibr73-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Mizuno S, Kawamura K, Hanamura I, et al. Efficacy and safety of autologous stem cell transplantation in elderly patients with multiple myeloma in the era of novel agents. Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 3437.","DOI":"10.1182\/blood-2018-99-109905"},{"key":"bibr74-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Saini NY, Patel R, Varma A, et al. Melphalan-based autologous transplantation in the octogenarian multiple myeloma patient population.Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 4608.","DOI":"10.1182\/blood-2018-99-110241"},{"key":"bibr75-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2001.02976.x"},{"key":"bibr76-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-018-0142-9"},{"key":"bibr77-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0801479"},{"key":"bibr78-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.29.8216"},{"key":"bibr79-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.0023"},{"key":"bibr80-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.26"},{"key":"bibr81-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Dimopoulos MA, Mateos M-V, Cavo M, et al. One-year update of a phase 3 randomized study of daratumumab plus bortezomib, melphalan, and prednisone (D-VMP) versus bortezomib, melphalan, and prednisone (VMP) in patients (pts) with transplant-ineligible newly diagnosed multiple myeloma (NDMM): ALCYONE. Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 156.","DOI":"10.1182\/blood-2018-156"},{"key":"bibr82-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402551"},{"key":"bibr84-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Larocca A, Salvini M, De Paoli L, et al. Efficacy and feasibility of dose\/schedule-adjusted Rd-R vs. continuous Rd in elderly and intermediate-fit newly diagnosed multiple myeloma (NDMM) patients: RV-MM-PI-0752 phase III randomized study. Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract 305.","DOI":"10.1182\/blood-2018-99-111796"},{"key":"bibr85-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15261"},{"key":"bibr86-EDBK_239067","doi-asserted-by":"crossref","unstructured":"Facon T, Kumar SK, Plesner T, et al. Phase 3 randomized study of daratumumab plus lenalidomide and dexamethasone (D-Rd) versus lenalidomide and dexamethasone (Rd) in patients with newly diagnosed multiple myeloma (NDMM) ineligible for transplant (MAIA). Presented at: 60th Annual Meeting of the American Society of Hematology. San Diego, CA; 2018. Abstract LBA-2.","DOI":"10.1182\/blood-2018-120737"},{"key":"bibr87-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2015.05.013"},{"key":"bibr88-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1405158"},{"key":"bibr89-EDBK_239067","volume-title":"J Clin Oncol","volume":"35","author":"Gay FM","year":"2017"},{"key":"bibr90-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-04-422683"},{"key":"bibr91-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2014.110395"},{"key":"bibr92-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.148189"},{"key":"bibr93-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.46.2598"},{"key":"bibr94-EDBK_239067","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.1365-2141.2011.08849.x","volume":"155","author":"Jacobus SJ","year":"2011","journal-title":"Br J Haematol"},{"key":"bibr95-EDBK_239067","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/S1470-2045(10)70187-X","volume":"11","author":"Mateos MV","year":"2010","journal-title":"Lancet Oncol"},{"key":"bibr96-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-016-2901-x"},{"key":"bibr97-EDBK_239067","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1038\/s41375-018-0072-6","volume":"32","author":"Rodr\u00edguez-Otero P","year":"2018","journal-title":"Leukemia"},{"key":"bibr98-EDBK_239067","first-page":"3040","volume":"130","author":"Pawlyn C","year":"2017","journal-title":"Blood"},{"key":"bibr99-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-018-0098-9"},{"key":"bibr100-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa012528"},{"key":"bibr101-EDBK_239067","volume":"36","author":"De Celis ESP","year":"2018","journal-title":"J Clin Oncol"},{"key":"bibr102-EDBK_239067","first-page":"5662","volume":"130","author":"Auclair D","year":"2017","journal-title":"Blood"},{"key":"bibr103-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2016.390"},{"key":"bibr104-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-707596"},{"key":"bibr106-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.34.7625"},{"key":"bibr107-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.4327"},{"key":"bibr108-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26646"},{"key":"bibr109-EDBK_239067","doi-asserted-by":"publisher","DOI":"10.1097\/CCO.0000000000000395"}],"container-title":["American Society of Clinical Oncology Educational Book"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/EDBK_239067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T08:49:27Z","timestamp":1653814167000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/EDBK_239067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":104,"journal-issue":{"issue":"39","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1200\/EDBK_239067"],"URL":"https:\/\/doi.org\/10.1200\/edbk_239067","relation":{},"ISSN":["1548-8748","1548-8756"],"issn-type":[{"value":"1548-8748","type":"print"},{"value":"1548-8756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]}}}