Advances in treatment for newly diagnosed multiple myeloma patients ineligible for autologous stem cell transplantation.

The majority of newly diagnosed multiple myeloma patients are over 65 years and/or physically unfit, and, therefore, are not eligible for standard treatment with high-dose chemotherapy and stem cell transplantation. The treatment goals in these patients should be to ensure improvement in disease management and to prolong survival while ensuring quality of life. Until recently, treatment options for such patients were limited, but new treatment combinations based on the novel agents thalidomide, bortezomib and lenalidomide have improved outcomes and survival. Moreover, phase III data indicate that maintenance treatment with novel agents may contribute to extended progression-free survival; however, the optimal duration of long-term therapy has not yet been defined. The potential for novel treatment regimens to improve the adverse prognosis associated with high-risk cytogenetic profiles, such as deletion 17p, also requires further research. Elderly patients, particularly those over 75 years and the clinically vulnerable, require close monitoring and individualized, dose-modified regimens to improve tolerability and treatment efficacy, while maintaining quality of life.