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Elderly Myeloma with Spine Fractures
Is the elderly myeloma patient with spine fractures a treatment problem?
Hi David, my husband has been diagnosed with Multiple Myeloma. He is 78 years old. Has several fractures in his back. Looking for opinions on this condition. We live in Canada
Multiple myeloma treatments within the elderly population
What is kyphoplasty, what is vertebroplasty, when should these procedures be considered?
Sorry to learn of your husband’s diagnosis. While I’m a long-term MM survivor, I’m not sure what your health system covers and what it does not, so keep this in mind.
Two main issues to keep in mind. First, MM oncology has gotten good at stabilizing the advanced MM patient. In your case, this means that induction therapy should be able to put your husband into remission. Kyphoplasty, vertebroplasty, and jack therapy should be able to stabilize his spine as well as reduce or even eliminate the pain. He may need physical therapy as well.
However, conventional oncology generally treats MM aggressively. This may be fine for the average MM patient, but research shows that MM moves more slowly in the elderly patient (elderly is defined as over 75).
All to say, it may be necessary to treat your husband aggressively to stabilize him, but aggressive toxicity over time can be counterproductive.
Oncology usually pushes aggressive chemo in hopes of achieving a deep remission. However, aggressive chemo can cause real damage to the MM patient. Many MM survivors live normally with a little MM in their bone marrow. It is okay to live with a low m-spike, for example.
Let me know if you have any questions.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Myeloma in Elderly Patients: When Less Is More and More Is More
Multiple myeloma (MM) is a plasma cell malignancy that occurs among older adults and accounts for 15% of all hematologic malignancies in the United States. Thirty-five percent of patients are diagnosed at age 75 or older.
Novel therapeutics and routine use of autologous stem cell transplantation (ASCT) have led to substantial improvements in patient survival, although improvements have been more impressive among patients younger than age 65.
Finding the balance between under- and overtreating elderly patients is one of the biggest challenges specific to them as a subgroup of patients with MM. Decision making about which therapies and their dose intensity and duration should be influenced by a patient’s
- functional status,
- personal preferences,
- disease characteristics,
- and the ability to tolerate therapy.
ASCT should be considered for all patients younger than age 80, assuming that they are not frail. The attainment of a stringent complete response and minimal residual disease negativity is associated with improved progression-free and overall survival. Again, consideration of quality of life for these patients is paramount. Although there is a growing list of tools to sort through these issues, a fully integrated approach has not yet been finely tuned, leaving additional work to be done for the treatment of elderly patients with MM.
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