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Ludwig H, Sonneveld P, Davies F, Bladé J, Boccadoro M, Cavo M, Morgan G, de la Rubia J, Delforge M, Dimopoulos M, Einsele H, Facon T, Goldschmidt H, Moreau P, Nahi H, Plesner T, San-Miguel J, Hajek R, Sondergeld P, Palumbo A. European perspective on multiple myeloma treatment strategies in 2014. Oncologist 2014; 19:829-44. [PMID: 25063227 PMCID: PMC4122482 DOI: 10.1634/theoncologist.2014-0042] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The treatment of multiple myeloma has undergone significant changes and has resulted in the achievement of molecular remissions, the prolongation of remission duration, and extended survival becoming realistic goals, with a cure being possible in a small but growing number of patients. In addition, nowadays it is possible to categorize patients more precisely into different risk groups, thus allowing the evaluation of therapies in different settings and enabling a better comparison of results across trials. Here, we review the evidence from clinical studies, which forms the basis for our recommendations for the management of patients with myeloma. Treatment approaches depend on "fitness," with chronological age still being an important discriminator for selecting therapy. In younger, fit patients, a short three drug-based induction treatment followed by autologous stem cell transplantation (ASCT) remains the preferred option. Consolidation and maintenance therapy are attractive strategies not yet approved by the European Medicines Agency, and a decision regarding post-ASCT therapy should only be made after detailed discussion of the pros and cons with the individual patient. Two- and three-drug combinations are recommended for patients not eligible for transplantation. Treatment should be administered for at least nine cycles, although different durations of initial therapy have only rarely been compared so far. Comorbidity and frailty should be thoroughly assessed in elderly patients, and treatment must be adapted to individual needs, carefully selecting appropriate drugs and doses. A substantial number of new drugs and novel drug classes in early clinical development have shown promising activity. Their introduction into clinical practice will most likely further improve treatment results.
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Affiliation(s)
- Heinz Ludwig
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Pieter Sonneveld
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Faith Davies
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Joan Bladé
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Mario Boccadoro
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Michele Cavo
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Gareth Morgan
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Javier de la Rubia
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Michel Delforge
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Meletios Dimopoulos
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Hermann Einsele
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Thierry Facon
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Hartmut Goldschmidt
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Philippe Moreau
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Hareth Nahi
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Torben Plesner
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Jesús San-Miguel
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Roman Hajek
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Pia Sondergeld
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Antonio Palumbo
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
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Tuchman SA, Shapiro GR, Ershler WB, Badros A, Cohen HJ, Dispenzieri A, Flores IQ, Kanapuru B, Jurivich D, Longo DL, Nourbakhsh A, Palumbo A, Walston J, Yates JW. Multiple myeloma in the very old: an IASIA conference report. J Natl Cancer Inst 2014; 106:dju067. [PMID: 24700806 DOI: 10.1093/jnci/dju067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma (MM) in patients aged greater than 80 years poses an increasingly common challenge for oncology providers. A multidisciplinary workshop was held in which MM-focused hematologists/oncologists, geriatricians, and associated health-care team members discussed the state of research for MM therapy, as well as themes from geriatric medicine that pertain directly to this patient population. A summary statement of our discussions is presented here, in which we highlight several topics. MM disproportionately affects senior adults, and demographic trends indicate that this trend will accelerate. Complex issues impact cancer in seniors, and although factors such as social environment, comorbidities, and frailty have been well characterized in nononcological geriatric medicine, these themes have been inadequately explored in cancers such as MM, despite their clear relevance to this field. Therapeutically, novel agents have improved survival for MM patients of all ages, but less so for seniors than younger patients for a variety of reasons. Lastly, both MM- and treatment-related symptoms and toxicities require special attention in senior adults. Existing research provides limited insight into how best to manage these often complex patients, who are often not reflected in typical clinical trial populations. We hence offer suggestions for clinical trials that address knowledge gaps in how to manage very old and/or frail patients with MM, given the complicated issues that often surround this patient population.
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Affiliation(s)
- Sascha A Tuchman
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
| | - Gary R Shapiro
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - William B Ershler
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Ashraf Badros
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Harvey J Cohen
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Angela Dispenzieri
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Irene Q Flores
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Bindu Kanapuru
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Donald Jurivich
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Dan L Longo
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Ali Nourbakhsh
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Antonio Palumbo
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Jeremy Walston
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Jerome W Yates
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
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