What is multiple myeloma, its typical age of onset, and its treatment?

From the Guidelines

Multiple myeloma is a cancer of plasma cells that typically develops in older adults, with a median age of diagnosis around 70 years, and its treatment depends on several factors including the stage of disease, patient's age, and overall health. The disease is characterized by the proliferation of malignant plasma cells in the bone marrow, leading to end-organ damage such as hypercalcemia, renal insufficiency, anemia, and bone lesions 1. The treatment of multiple myeloma has evolved dramatically over the past decade, with the introduction of new drugs and combination regimens that have significantly improved overall survival 1. Standard treatments include chemotherapy regimens such as VRd (bortezomib, lenalidomide, dexamethasone) or KRd (carfilzomib, lenalidomide, dexamethasone), often followed by autologous stem cell transplantation in eligible patients 1. Some key points to consider in the treatment of multiple myeloma include:

• Maintenance therapy with lenalidomide or other agents is typically used after initial treatment to prolong remission 1
• Newer treatments include monoclonal antibodies like daratumumab, immunomodulatory drugs, proteasome inhibitors, and CAR-T cell therapy for relapsed/refractory disease 1
• Supportive care is also essential and includes medications for bone health (bisphosphonates), pain management, and prevention of infections 1
• Regular monitoring of blood counts, kidney function, and protein levels is necessary throughout treatment to assess response and manage side effects 1 The goal of treatment is to control the disease, minimize its end-organ effects, and improve quality of life, with modern treatments having significantly extended survival, and many patients living 5-10 years or longer after diagnosis.

From the FDA Drug Label

The median age was 58 years (range: 22 to 65 years) The median patient age was 65 years (range 34 to 89 years)

• Multiple Myeloma: is a type of cancer that forms in a type of white blood cell called a plasma cell.
• Typical Age of Onset: The median age of onset is around 58-65 years.
• Treatment: The treatment for multiple myeloma includes:
  • Daratumumab in combination with bortezomib, thalidomide, and dexamethasone.
  • Lenalidomide and dexamethasone.
  • Bortezomib alone or in combination with dexamethasone. 2 3

From the Research

Multiple Myeloma Overview

• Multiple myeloma is a hematologic malignancy characterized by the presence of abnormal clonal plasma cells in the bone marrow, with potential for uncontrolled growth causing destructive bone lesions, kidney injury, anemia, and hypercalcemia 4.
• It is diagnosed in an estimated 34,920 people in the US and in approximately 588,161 people worldwide each year 4.

Age of Onset

• The typical age of onset for multiple myeloma is not explicitly stated in the provided studies, but it is known that the risk of developing multiple myeloma increases with age.

Treatment

• Standard first-line (induction) therapy consists of a combination of an injectable proteasome inhibitor (e.g., bortezomib), an oral immunomodulatory agent (e.g., lenalidomide), and dexamethasone, and is associated with median progression-free survival of 41 months 4.
• Induction therapy combined with autologous hematopoietic stem cell transplantation followed by maintenance lenalidomide is standard of care for eligible patients 4.
• Other treatment options include:
  • Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide 5.
  • Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma 6.
  • Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation 7.

Treatment Efficacy

• The combination of pomalidomide, bortezomib, and dexamethasone has shown promising results in phase 1/2 trials of patients with relapsed or refractory multiple myeloma, with significantly improved progression-free survival compared to bortezomib and dexamethasone alone 5.
• The addition of bortezomib to lenalidomide and dexamethasone resulted in significantly improved progression-free and overall survival in patients with newly diagnosed myeloma, with an acceptable risk-benefit profile 8.
• The addition of daratumumab to lenalidomide, bortezomib, and dexamethasone improved depth of response in patients with transplant-eligible newly diagnosed multiple myeloma, with no new safety concerns 6.
• The KRd regimen (carfilzomib, lenalidomide, and dexamethasone) did not improve progression-free survival compared to the VRd regimen (bortezomib, lenalidomide, and dexamethasone) in patients with newly diagnosed multiple myeloma, and had more toxicity 7.