A study assessed treatments for myeloma, noting advancements in patient outcomes due to proteasome inhibitors and immunomodulatory drugs, yet acknowledging persistently poor results in high-risk cases marked by rapid disease progression. These outcomes are influenced by both patient factors like comorbidities and limited treatment tolerance, and tumor factors including chromosomal abnormalities and resistance to apoptosis. High-risk myeloma is linked to a variety of chromosomal issues, with certain translocations and abnormalities like t(4;14), t(14;16), t(14;20), del(17p), and gain/amp(1q) associated with particularly poor prognoses.

The Myeloma XI trial, involving 3,894 patients, examined the effects of age on treatment outcomes using cyclophosphamide, lenalidomide, and dexamethasone combinations. The study revealed that factors like the International Staging System (ISS) and cytogenetic risk vary in their impact based on patient age, with ISS becoming more influential in older patients. Specifically, older patients (above 80) had notably poorer outcomes compared to younger ones. The study emphasizes the importance of age-appropriate risk assessment and the necessity for personalized treatment strategies tailored to individual patient and tumor characteristics.

Reference: Pawlyn C, Cairns D, Kaiser M, et all. The relative importance of factors predicting outcome for myeloma patients at different ages: results from 3894 patients in the Myeloma XI trial. Leukemia. 2020 Feb;34(2):604-612. doi: 10.1038/s41375-019-0595-5. Epub 2019 Oct 14. PMID: 31611625; PMCID: PMC7214257.