Concise review - Treatment of multiple myeloma in the very elderly: How do novel agents fit in?

In the last decades, treatment of multiple myeloma (MM) has greatly improved due to the introduction of novel agents, including proteasome inhibitors (PI) and immunomodulatory agents (IMiDs). Given their generalized use at diagnosis and at relapse and their proven benefit for the large cohort of MM patients, it is of pivotal importance to also critically evaluate any benefit of these agents in very elderly (>75years) and frail patients. This review gives an overview of the benefits and toxicities of the currently available treatments in very elderly MM patients with a focus on first-line treatment. In addition we discuss the role of geriatric assessment to optimize treatment efficacy in the more vulnerable cohort.