SCIENTIFIC PROGRAMME
SESSION I
HOW I TREAT
SMOLDERING MYELOMA
(SMM)
SESSION II
HOW I TREAT NEWLY
DIAGNOSED MULTIPLE
MYELOMA
SESSION III
FROM RISK
STRATIFICATION TO
RISK-BASED THERAPY?
DEBATE 1
SHOULD WE USE MRD
TESTING TO DETERMINE
THERAPY IN MULTIPLE
MYELOMA?
DEBATE 2
IS THERE A FUTURE ROLE
OF AUTOLOGOUS STEM
CELL TRANSPLANTATION?
SESSION IV
HOW I TREAT RELAPSED
MULTIPLE MYELOMA
DEBATE 3
SHOULD EVERY PATIENT
RECEIVE DARATUMUMAB
IN FIRST LINE?
ROUNDTABLE
MULTIPLE MYELOMA
FROM THE PERSPECTIVE
OF FDA/EMEA AND
FOUNDATIONS
SESSION V
YOU CAN’T BE IMMUNE
FOR IMMUNE THERAPY
ANYMORE
SESSION VI
OTHER PLASMA CELL
DYSCRASIAS
KEYNOTE LECTURES
THE FUTURE OF
MULTIPLE MYELOMA
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
ABSTRACTS SELECTED
AS POSTERS
DISCLOSURES
ALESSANDRA LAROCCA (TURIN)
CASE-BASED LECTURE : NOVEL THERAPEUTIC APPROACHES FOR FRAIL MULTIPLE
MYELOMA PATIENTS
Division of Haematology, University of Turin, Turin, Italy
Multiple myeloma (MM) is a neoplastic disease of older adults, with a higher incidence in elderly
patients. The prevalence of myeloma is likely to increase due to the extended survival and the growing
life expectancy of the general population.
Much progress has been made in the past few years thanks to the introduction of new drugs. The
introduction of novel agents has considerably improved overall survival, primarily among patients over
65 years.
Aging is associated with a high prevalence of frailty, that is, a state of increased vulnerability to
stressors due to a critical decline in physiologic reserves. Elderly people may be categorized as fit or
frail according to clinical, functional and cognitive criteria. The presence of frailty may complicate the
management and outcome of myeloma patients.
To date, the choice of treatment of myeloma patients has focused primarily on chronological age and
performance status as markers of frailty. However, the elderly population is highly heterogeneous, and
improved assessment strategies are needed to define the frailty profile of patients and provide them
with the most adequate treatment, thus avoiding the overtreatment of frail patients and the
undertreatment of fit patients.
The geriatric assessment (GA) is a fundamental tool for the evaluation of cognitive and functional
status.
In 2015 the International Myeloma Working Group defined a frailty score based on age, functional
status and independence through the Activities of daily living (ADL) and Instrumental ADL (IADL) scales,
and the evaluation of the number and severity of comorbidities with the Charlson Comorbidity Index
(CCI).
Rd and VMP combined with the monoclonal antibody daratumumab, are the current standards of care
for older patients with newly diagnosed myeloma. To date, there have been no prospective trials
evaluating geriatric assessment–driven treatments in elderly patients with newly diagnosed MM; the
best strategy for frail patients remains to be defined.
On the basis of the results of a geriatric assessment, patients can be stratified into a fit group, suitable
for full-dose therapy or a frail group, requiring dose-adjusted therapies.
Frail patients need effective tailored treatments to better control the disease while minimizing the risk
of toxicity and treatment discontinuation. The selection of therapy should be based on the risk of
toxicity and the capacity of patients to tolerate treatment. Lenalidomide and bortezomib have an
essential role in the treatment of frail patients. Ongoing and future studies will define more precise
geriatric assessment–directed treatment selection.