Multiple Myeloma in Older Adults: What to Know

Medically Reviewed by Melinda Ratini, MS, DO on June 30, 2022
Written by Shishira Sreenivas
6 min read

Your risk for multiple myeloma (MM) increases as you age. In fact, 35% of the patients are diagnosed at age 75 or older, including 10% who are 85 or older. The average age for this type of blood cancer is 70.

But if you’re over 65 and think you might have multiple myeloma, diagnosing and treating it might be a challenge. That’s because as you get older, you’re more likely to have other medical issues at the same time (comorbidities). They can mimic or seem similar to myeloma symptoms. Or these issues might affect your ability to tolerate therapy, if you do have MM.

Aging is one of the leading risk factors for MM. Other risk factors include:

  • Gender. Men are more likely to have multiple myeloma than women.
  • Race. Black people are more likely to develop it over other races.
  • Family history. If you have a close relative who has multiple myeloma, it can increase your risk.
  • History of a monoclonal gammopathy of undetermined significance (MGUS). It’s a condition in which an unusual protein called monoclonal protein (M protein) is found in your blood. It happens most in older men. M protein levels are low in MGUS. But multiple myeloma almost always starts out as MGUS.

When you’re 65 or older, signs and symptoms of myeloma can show up in many ways, including:

  • Unexplained anemia (low red blood cell count)
  • Fatigue
  • Bone pain
  • Fractures
  • Spinal cord compression
  • Too much calcium in your blood (hypercalcemia)
  • Kidney problems
  • Repeated infections
  • Thickening of blood (hyperviscosity)

Many of these symptoms, such as hypercalcemia and kidney problems, might overlap with other age-related illnesses, such as:

Also, anemia affects around 10% to as many as 44% of older adults. It’s often linked to a lack of iron in your blood, a long-term disease, or not enough vitamin B12, or folate.

People in this age group often have more than one medical problem. If you have MM symptoms, your doctor will have to run several tests to rule out other causes.

Research says there can be a 6-month delay from the time you notice symptoms until you can get a diagnosis. In about half of the cases, people need at least three visits before they can get a referral to an oncologist, a cancer doctor. A delay in diagnosis will also cause a delay in when you can start treatments. During this time, your symptoms may get worse.

If you have multiple myeloma, you may run into some challenges in managing it. That’s because your symptoms, treatments, and odds of recovery depend on your overall health, fitness, and other things, including:

  • Many age-related medical issues
  • Delay in diagnosis
  • Low tolerance to therapies
  • Limited evidenced-based research for effective treatments for older adults
  • Treatments that may not be as effective
  • Higher risk of blood clots, nerve damage (neuropathy), and infections

With MM, your doctor will consider many things before they decide on the right treatment plan for you. One reason is as you age, you’re more likely to become “frail.” Medically, you’re defined as frail if you have three of these:

  • Muscle weakness
  • Physical exhaustion
  • Low physical activity
  • Slowness, especially when walking
  • Shrinking and weight loss

Doctors estimate 7%-12% of Americans 65 and older are frail.

Frailty increases your odds for other medical problems like infections, falls, and disabilities. It also affects your ability to tolerate certain MM therapies such as chemotherapy, biologics, or stem cell transplant.

Your doctor can use “geriatric assessment tools” to help figure out a treatment plan. This allows them to give your health a rating or score based on several things, like:

  • Age
  • Independence in daily activities like driving, bathing, eating, using the bathroom, and doing chores around the house, among other things
  • Other medical conditions you have (the Charlson comorbidity index)
  • How well your organs are working
  • Medical history
  • Psychosocial status, which looks at your mental health and how well you function in the community

Your doctor will take your personal preferences into account. If you have a caregiver, they’ll include their opinions, too. The score or rating will help them decide whether you’re strong enough to have intense therapies or if you need milder treatments to improve your quality of life.

Once your doctor takes all this into account and figures out your MM stage and risk category, they'll recommend a plan that suits you.

This can include a combination of:

  • Chemotherapy. These drugs kill fast-growing cells like myeloma cells. Your doctor may also give you high doses to get ready for a bone marrow transplant (see below).
  • Corticosteroids (steroids). These drugs can help your immune system control inflammation. They also fight myeloma cells.
  • Immunotherapy. These are drugs that boost your immune system to fight cancer cells.
  • Radiation therapy. This therapy uses high-powered beams like X-rays to kill cancer cells and shrink tumors.
  • Stem cell transplant (bone marrow transplant). This procedure replaces bone marrow that has cancer in it with healthy bone marrow.
  • Targeted therapy. These drugs focus on certain traits in cancer cells and cause them to die.

Autologous stem cell transplant is usually the standard treatment for MM. That means your own stem cells are used to work to make your blood healthy again. During this therapy, your doctor will collect stem cells (healthy blood-forming cells) from your bone marrow. It’s the spongy tissue found inside your bones. They can also collect them from the surrounding blood.

Before the transplant procedure, you’ll get a heavy dose of chemo. The aim is to lower the number of cancer cells in your body. You might also get radiation. Once that’s done, your doctor will put the stored stem cells back into your blood through a vein.

People who are younger than 65 usually respond well to chemo drugs and are ideal candidates. But because of recent advances in medicine, some people who are 80 or older can now qualify for such treatments, too. Research shows it can extend the length and quality of your life. But not everyone can tolerate stem cell transplant. The older you are, the more likely you are to have serious complications.

If your doctor believes you're frail, you might not be eligible for stem cell transplant. They may also rule out the option if you have other medical problems or score low on activity or fitness tests.

In such cases, your doctor will likely give you a combination of two to three immunomodulatory drugs (bortezomib, daratumumab, and lenalidomide). Along with this, they’ll usually give you corticosteroids such as dexamethasone. This is called maintenance therapy.

The goal is to keep your symptoms from getting worse. If one or more drugs don’t work for you, let your doctor know. They can switch or adjust your dosage to suit your needs.

There’s no cure for multiple myeloma. But your age plays a big role. Research says the overall chance of survival with MM is short if you’re 66 or older. It’s even shorter for those older than 75. But medical care has improved. So have the survival rates for older adults who get a combination of newer drugs.

One recent study looked at 3,449 MM patients to study their 4-year survival rate. For those who were 65-75 years old, their odds of survival went up by 27%. As for those who were 75 or older, the survival rates rose by 32%.

Also, supportive care such as physical therapy, massage, and nutrition have improved. This can also improve your quality of life.