Symptomatic myeloma

Newly diagnosed patients who require therapy fall into two categories: (1) patients in good or well-controlled health (previously referred to as the fit, transplant-eligible patient) or (2) the less-fit patient with significant comorbidities or advanced age (previously referred to as not transplant eligible). Comorbidities and performance status are important determinants to help decide about fitness of patients at all ages, especially those between the ages of 70 years and 80 years. Nomograms exist for geriatric patients to define life expectancy independent of the myeloma diagnosis.[7] Age, organ dysfunction, and risk of cardiovascular and thrombotic complications influence the choice of induction therapies. These factors are also important when considering consolidation therapies, such as chimeric antigen receptor T-cell therapy, bispecific antibody therapy, and autologous stem cell transplant (SCT) consolidation. Most patients also receive a bisphosphonate or RANKL inhibitor to prevent skeletal-related complications.[8,9]

The International Myeloma Working Group has issued guidance for the diagnosis and management of patients with renal impairment.[10]