Treatment of multiple myeloma in the elderly: realities and hopes.

Until recently, combination chemotherapy with melphalan and prednisone (MP) has remained the most widely accepted treatment option for elderly patients with multiple myeloma (MM). However, since the availability of new and more active drugs, several groups have compared in several phase III trials the efficacy and safety of MP versus MP-based therapies including new agents such as thalidomide (MPT) or bortezomib (MPV). In all these studies response rate and progression-free survival were superior in patients receiving MPT or MPV. However, these new combinations are not without side effects, and the incidence of grade 3 and 4 toxicities is higher than that reported with MP. Besides, the median duration of the complete remissions obtained with these new combinations is still insufficient, ranging from 15 to 27 months, and new therapeutic alternatives are still needed in this subset of patients. The purpose of this review article is to summarize the currently available data in the front-line treatment of elderly patients with MM and to discuss which questions are still unsolved in the management of this subset of patients.