Sequential treatment of high-risk myeloma in an elderly patient. Case report

Abstract

Multiple myeloma is a neoplasm that primarily affects elderly patients, with an average age of diagnosis of 70 years. Elderly patients with high-risk genetic myeloma are underrepresented in clinical studies and pose a challenging group to treat, with a median survival of less than two years. Advanced age brings comorbidities and frailty, which result in poor tolerance to therapies and increased mortality, necessitating the use of less intensive treatments aimed at disease control and maintaining quality of life. In contrast, for high-risk myeloma, deep responses are sought through the use of triplets to overcome the adverse effects of cytogenetics. Thus, treating high-risk myeloma in elderly patients presents the challenge of requiring effective treatments in frail individuals with poor tolerance. We present the case of an 84-year-old patient with high-risk genetic myeloma determined by the amplification of 1q21, who received successive treatments based on lenalidomide, bortezomib, daratumumab, and carfilzomib, successfully maintaining disease control for over six years. This case documents that in elderly patients with high-risk disease, continuous treatment with effective drugs, appropriate dosaje adjustments and supportive care can keep the disease under control with minimal toxicity and prolong the survival of the elderly patient.