Insights into very elderly multiple myeloma treatment from Kansai Myeloma Forum

With the aging population, there is a growing need for treating multiple myeloma (MM) in elderly patients; however, real-world studies of them are quite limited. We retrospectively analyzed 519 patients diagnosed between 1997 and 2020 in the Kansai Myeloma Forum database to evaluate the efficacy and safety of novel agents available for 80 years and older patients with MM. Patients were divided into groups according to the treatment year: up to 2010 (Group 1), 2011–2015 (Group 2), and 2016−2020 (Group 3). The median age and number of treatment lines were 83 years (range, 80-96) and 2, respectively. The median time to next treatment (TTNT) was 7.8 months. The TTNT for Group 3 was significantly shorter (3.8 months) than in other groups (<i>p</i> &lt; 0.001). Median progression free survival and overall survival (OS) were 24.4 and 43.7 months, respectively, and did not differ significantly between 3 groups based on pairwise comparisons. In Group 3, the 1-year cumulative incidence of adverse events (AEs), progression or death, and planned treatment leading to treatment discontinuation was 37.7%, 29.4%, and 15.6%, respectively. In addition, the median time until discontinuation due to AEs has been shortened in recent years. Our findings suggest that AEs threaten the continued treatment of very elderly patients receiving novel agents, with careful management needed to extend the TTNT. <b>What is the context?</b>Multiple myeloma (MM) is a type of blood cancer that becomes more common with age.Very elderly MM patients (≥80 years old) rarely receive two or more lines of treatment.While advancements in treatments have improved outcomes for MM, elderly patients often struggle to tolerate these therapies. This highlights the need for more real-world evidence. Multiple myeloma (MM) is a type of blood cancer that becomes more common with age. Very elderly MM patients (≥80 years old) rarely receive two or more lines of treatment. While advancements in treatments have improved outcomes for MM, elderly patients often struggle to tolerate these therapies. This highlights the need for more real-world evidence. <b>What is new?</b>This study showed evolution in therapeutic regimen for very elderly newly diagnosed MM patients in Japan over time.In this study, we found that while newer medications are being used more frequently, the duration of initial treatment has shortened, primarily due to adverse effects rather than disease progression, leading to treatment discontinuation. This study showed evolution in therapeutic regimen for very elderly newly diagnosed MM patients in Japan over time. In this study, we found that while newer medications are being used more frequently, the duration of initial treatment has shortened, primarily due to adverse effects rather than disease progression, leading to treatment discontinuation. <b>What is the impact?</b>For very elderly MM patients, treatment strategies need to be personalized, including dose reductions, to extend the duration of therapy.This study emphasizes the importance of carefully managing treatment regimens, especially adverse effects, to ensure better outcomes. For very elderly MM patients, treatment strategies need to be personalized, including dose reductions, to extend the duration of therapy. This study emphasizes the importance of carefully managing treatment regimens, especially adverse effects, to ensure better outcomes.