Diffuse large B-cell lymphoma is the most prevalent non-Hodgkin lymphoma among the elderly. Yet, limited data exists on how best to treat older patients with this disease because their comorbidities and poor functional status make them ineligible for related clinical trials.

Multiple myeloma (MM) is also most commonly diagnosed among older adults. Treatment options for older patients have been expanding in recent years with many older adult-specific trials testing novel drugs and sequential treatment strategies which have positively changed the natural history of the disease.  

  • Multiple Myeloma in the Older Adult: Better Prospects, More Challenges: This review article in the Journal of Clinical Oncology addresses treatment approaches for older adults who are eligible for and those ineligible for stem cell transplantation. The review discusses existing evidence from clinical trials as well as the role of refined approaches including geriatric assessment.
     
  • Geriatric Assessment Predicts Survival and Toxicities in Elderly Myeloma Patients: An International Myeloma Working Group report: This study published in Blood pooled data from 3 large prospective trials including over 800 patients to test the utility of geriatric assessment in predicting outcomes for older adults with multiple myeloma. The study demonstrated that a simple “fitness” score could be constructed from assessment of comorbidity, activities of daily living, and instrumental activities of daily living which predicted mortality and risk of toxicity. This score is proposed for use in future clinical trials.
     
  • Lenalidomide and Dexamethasone in Transplant-Ineligible Patients With Myleoma: Treatment for many older adults who were not eligible for stem cell transplantation due to comorbidity or functional status has evolved in recent years. This randomized trial published in the NEJM compared the prior standard therapy, melphalan-prednisone-thalidomide, with a new regimen, lenalidomide and low dose dexamethasone. Continuous lenalidomide with dexamethasone was associated with significant improvement in progression free survival, suggestion of overall survival benefit, and was better tolerated. This established a new standard of care for first line therapy among older adults ineligible for transplantation.
     
  • Triplet Versus Doublet Lenalidomide-Containing Regimens for the Treatment of Elderly Patients With Newly Diagnosed Multiple Myeloma: Three drug-containing regimens (versus two) are commonly used in the treatment of multiple myeloma. However the trade-off related to toxicity is particularly of concern among older adults who may be at greater risk for treatment side effects and the negative functional consequences associated with them. This study published in Blood tested two different triple drug regimens against the standard doublet of lenalidomide and low dose dexamethasone among older adults. The results showed no superiority of the triplet regimens over the standard doublet, which was also associated with fewer side effects.
     
  • Community-Based Phase IIIb Trial of Three UPFRONT Bortezomib-Containing Myeloma Regimens: Bortezomib-based therapy is an active and well tolerated treatment for older adults multiple myeloma. This study, published in the Journal of Clinical Oncology, addresses the question of whether bortezomib-based three drug regimens (triplets) versus a two drug regimen (doublet) were superior as initial therapy for older patients (mean age>70 years) ineligible for transplantation. While all regimens demonstrated high response rates, there was no clear advantage for triplet therapy compared with bortezomib-dexamethasone. This study suggests that doublet therapy may offer similar disease control with fewer side effects for older patients with multiple myeloma.