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Myeloma in the Elderly- Minimize Toxicity-Increase Non-Toxic Therapies

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“Toxicity (for elderly Multiple Myeloma patients) is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status.”

When I underwent an autologous stem cell transplant for multiple myeloma (MM) in December of 1995 I could barely climb the stairs to my condo when I returned home. I was 35 years old and the toxicity aged me tremendously.

If I had such a difficult time with conventional therapies during my induction therapy, and ASCT, I cannot imagine what the elderly MM patient must endure.

My research and experience tells me that elderly MM patients must think “less is more.”

I am both a myeloma survivor and myeloma cancer coach. While chemotherapy regimens for MM have improved in the past dozen years or so, make no mistake, chemotherapy regimens such as melphalan, thalidomide and revlimid discussed in the article linked and excerpted below are highly toxic. This toxicity will cause short, long-term and late stage side effects.

Please consider evidence-based, non-toxic, anti-MM therapies and/or therapies that integrate with FDA approved myeloma therapies. While I agree that the newly diagnosed MMer may undergo chemotherapy in order to bring his/her MM under control, I think it is important to learn about integrative and complementary MM therapies.

I have lived in complete remission from my MM since 1999 by living an evidence-based, non-toxic, anti-MM lifestyle through diet, supplementation, bone health and more.

To learn more about evidence-based, non-conventional, non-toxic therapies, managing and alleviating side effects, and overall structuring your life to support your body and fight Multiple Myeloma, please email me.

To Learn More about T-cell exhaustion and cancer- click now

Let me know if you have any questions.


David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Multiple Myeloma in the Elderly: When to Treat, When to Go to Transplant

“Until recently, standard treatment of multiple myeloma (MM) in elderly patients who were not candidates for autologous stem cell transplantation was with the combination of melphalan plus prednisone (MP). Novel agents (thalidomide, lenalidomide, bortezomib) are dramatically changing frontline therapy of MM. Randomized studies have shown the superiority of adding one novel agent to MP, either thalidomide (MPT) or bortezomib (MPV)…

However, toxicity (in the elderly MMer) is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status. Weekly bortezomib appears to induce severe peripheral neuropathy less frequently than the same agent administered twice weekly…

Age is an important prognostic factor in MM, and overall survival (OS) declines continuously by decade from age 50 to ages greater than 80.[1] This decline in OS may be explained in part by the higher incidence of more severe disease in older patients, but it is mainly explained by patient characteristics (eg, performance status, comorbities).[1,2]

Elderly patients do not tolerate chemotherapy-related adverse events as well as younger patients, and they are rarely candidates for high-dose therapy (HDT)…”

Treatment of Multiple Myeloma in Elderly Patients: A Review of Literature and Practice Guidelines

“Patients older than age 75 are at increased risk of frailty, vulnerable to adverse events associated with high-dose chemotherapy and they are rarely candidates for high dose therapy (HDT) plus autologous stem cell transplant (ASCT).

However, the availability of new front-line treatment regimens based on the novel agents thalidomide, bortezomib, and lenalidomide have dramatically changed the management of MM in transplant-ineligible patients.

In addition, the goals of therapy in the elderly patients may differ from younger patients; older adults are more likely to prioritize symptom control, prolonged treatment-free intervals, and good quality of life over prolonged survival [, , ].

In this review, we provide a summary of data supporting the current management of elderly patients with newly diagnosed multiple myeloma…


In conclusion, the availability of new combination regimens and enhanced safety of ASCT has increased the treatment options for elderly patients with multiple myeloma.

Combination therapies including novel agents have improved the response and survival rates in transplant-ineligible patients. MPT, MPV, and lenalidomide/dexamethasone represent new standards of care for transplant-ineligible MM patients.

It is important to assess each patient’s clinical situation and fitness for therapy to allow treatment to be provided at an appropriate intensity.

Particular care must be taken to minimize toxicities, reducing doses if required, to allow continuation of treatment when appropriate.

Treating myeloma in the very elderly is challenging, and clinicians should develop a personalized approach to optimize the treatment response while minimizing toxicity through careful geriatric assessment and compassionate care…”




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