Treating elderly MM patients is challenging because of the heterogeneity of this patient population. This needs to be taken into consideration when choosing treatments.

Full dose ASCT can be considered in patients <65 years of age. Between the ages of 65-70, reduced intensity ASCT can still be offered, with the use of melphalan. Over the age of 70, treatment choice will be influenced by patient ‘biological fitness’. A geriatric assessment can be employed to help determine which elderly patients may be appropriate for full dose or reduced dose therapies. Novel agents, such as bortezomib can be used in the majority of elderly patients, in combination with melphalan-prednisone (MPV) up to nine cycles (9-12 months). Melphalan-prednisone plus thalidomide (MPT) is considered as an option for patients who cannot tolerate MPV or who cannot come to the hospital. In the biologically unfit patient, a two drug regimen with a 50% dose reduction could be considered.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).