PROMOTION OF HEALTH-RELATED QUALITY OF LIFE IN THE TREATMENT OF ELDERLY PATIENTS WITH MULTIPLE MYELOMA: AN INTEGRATIVE REVIEW (Atena Editora)

Abstract

Multiple myeloma (MM) is a hematological neoplasm with malignant transformation of plasma cells, resulting in uncontrolled growth in the bone marrow and secretion of non-functional monoclonal antibodies into the circulation. It causes damage to target organs due to the clinical manifestation of “CRAB” symptoms: hypercalcemia, renal failure, anemia and lytic bone lesions. MM is the second most common hematological malignancy after lymphomas. From 1990 to 2016, its global incidence increased by 126%, being related to population aging, as the disease typically occurs in the elderly, on average at age 70. Considering the impact on the health of those affected by MM and the greater prevalence of the disease in old age, this work aims to analyze evidence about treatment and care, which provide a better quality of life for those with the pathology, especially elderly patients. This is a qualitative, retrospective and cross-sectional study carried out through an integrative literature review. The databases used were PubMed and LILACS. The search considered the descriptors “aged”, “multiple myeloma”, “quality of life”, using the Boolean operator “AND”. Articles published in the last 11 years were included; in English, Spanish and Portuguese, free access and articles whose studies were clinical trials and controlled and randomized clinical trials. After applying the criteria, 10 articles were selected. Treatment with daratumumab, lenalidomide and dexamethasone, compared to lenalidomide and dexamethasone, presents greater efficacy with faster and more sustained clinically significant improvements, including pain, without resulting in an increase in adverse events. The inclusion of prophylactic levofloxacin in the treatment of MM resulted in a reduction in mortality from infectious events. Melphalan, prednisone and lenalidomide followed by lenalidomide maintenance, compared to the melphalan-prednisone regimen, prolonged disease progression-free survival. Daratumumab – bortezomib -melphalan -prednisone guaranteed functional and symptom improvements. Comprehensive geriatric assessment is useful in classifying risk and directing care in elderly people with MM. Predictive prognostic scales help define and optimize care, through minimal clinically important differences. To assess the prognosis, it is useful to base it on age and easily identifiable laboratory parameters such as LDH, CRP, lymphocyte/total white blood cell ratio. It is concluded that strategies to establish the diagnosis early, the cautious use of medications, management of polypharmacy and application of prognostic scales are essential in the management of the pathology, in order to guarantee a better quality of life in elderly patients affected by this condition. Regarding physical function, there is still a lack of studies aimed at improving physical capacity in this population.