Dr. Kumar on the Management of Elderly Patients With Multiple Myeloma

Shaji Kumar, MD, professor of Medicine, Mayo Clinic, discusses the management of elderly patients with multiple myeloma.

Myeloma is a disease of older patients, says Kumar, therefore it is extremely important to take into account the patients’ age and potential comorbidities. These might include diabetes and high blood pressure, among others. Such comorbidities could be particularly relevant as they relate to the drugs used to treat patients with this disease. Many of the drugs used in myeloma can have adverse effects on the heart, for example, so oncologists must be aware of these pre-existing conditions before administering certain drugs to their patients.

In addition to drug choices, oncologists also need to consider the dose of these drugs. Given that many of these patients tend to already be on other drugs when they seek treatment for myeloma, drug interactions between these different agents could potentially be dangerous to a patient’s health. They may not be able to metabolize the drugs as well as younger patients do. Some form of dose modification needs to be considered when treating older patients with multiple myeloma. It’s actually safer, says Kumar, to start these patients on a smaller dose, and understand their tolerance, before administering higher doses of the treatment.