Manmeet S. Ahluwalia, MD, Department of Internal Medicine, Fairview Hospital, Cleveland Clinic Health System, Cleveland, OH, USA.
Hamed A. Daw, MD, The Cleveland Clinic Cancer Center, Cleveland, OH, USA.

Multiple myeloma (MM) is a neoplasm of plasma cells that is characterized by tumour cell tropism of the bone marrow and production of monoclonal immunoglobulins (Ig) detectable in serum and/or urine. It often manifests as one or more of lytic bone lesions, monoclonal protein in the blood or urine, disease in the bone marrow, renal failure, anemia, and hypercalcemia. Better understanding of the biology of myeloma has led to the development of agents, such as bortezomib, CC-5013, and thalidomide, that target the myeloma cell and the bone-marrow microenvironment. Ongoing trials promise to define the roles of new agents, mini-allogeneic transplantation, and maintenance therapy.
Key words: bone marrow, biology, transplant, chemotherapy, multiple myeloma.

Rhonda Witte, BSc

It is one thing to know how the body changes with age, but it is another to understand the effects of these changes on the body. Decreased kidney size? A smaller liver? They may sound like minor changes, but it is crucial to understand the significance of such age-related changes in terms of selecting appropriate drug therapy. Geriatric clinical pharmacology is not a large part of the general practice of medicine but with an increasing elderly population, greater knowledge in this area is required.¹ What must be kept in mind is that it is not just about what drugs should be prescribed to the elderly--it is about the right drugs that should be prescribed to a geriatric patient on an individual basis.

Pharmacokinetics

Fundamental to geriatric medicine is the understanding of age-related changes in pharmacokinetics. Such changes have profound impacts upon drug usage in the elderly population. When ignored, severe complications and even death can result from pharmacotherapy. What makes the situation even more complicated is that pharmacokinetic changes vary with the individual. Therefore, each patient must be treated with a highly individualized approach² and one patient's situation cannot set the standard for other patients to follow.

Pharmacokinetics refers to time-dependent changes of drug concentration and their metabolites in the body, or more simply, what the body does to a drug.

Rhonda Witte, BSc

Our body's framework is subjected to continual use throughout our daily rituals. Whether we are walking, lifting, exercising or even rolling over in bed while we sleep, we depend on our skeletal system to function adequately. Amazingly, it handles a lot of use and is incredibly reliable. With age, however, our framework becomes less capable of withstanding the "wear and tear" of every day life. Research provides insight into the mechanisms behind the "normal" aging of the skeletal system. With this knowledge, we are gradually learning ways to counteract the effects of aging bone.

Rhonda Witte, BSc

Many alterations occur within the cardiovascular system with age. Structural changes can be noted through the pathological examination of aged hearts. The identification of such changes has helped us better understand the aging process. Research is also being conducted to reveal the changes in the aging heart at the cellular level.

Young adult heart (left) with the aging heart (right)

Growth and Structural Changes

Dr. Jagdish Butany of the Department of Laboratory Medicine and Pathobiology at The Toronto Hospital, General Division, outlined findings about age-related growth and structural changes associated with hearts of otherwise healthy, physically inactive persons over 65 years of age. In an interview, Dr. Butany stated that there does not appear to be any age-related changes at the ultrastructural level. Age-related changes can, however, be noted at the microscopic level.

Cardiac Valves

As one ages, changes in the valves are noticeable, particularly those concerning the aortic and mitral valves. An increase in the thickness of the aortic and mitral valves can be seen from decade to decade.

Rhonda Witte, BSc

The process of aging is familiar to every individual. Yet, despite this familiarity, it remains one of the greatest biological mysteries. We embark on the aging journey from the very moment we are born and proceed passively until our deaths. It is a concept that some find difficult to comprehend, perhaps because it is seemingly inevitable--beyond one's control.

A multitude of theories has been proposed regarding the aging process. The question "Why do we age?" has sparked interest in many research disciplines. Of particular interest are the neurological aspects of aging. Numerous examinations of the aging brain have been performed, particularly those concerning the neurodegenerative diseases of the elderly. Interestingly, studies using animal models have suggested that estrogen replacement therapy may have a role in both the treatment and prevention of dementia by assisting the regeneration and preservation of neuronal structures.¹ Close attention has also been given to the "normal" aging brain and the events that occur over a lifetime.

Along with the heart and striated muscle, the brain is the oldest part of the mammalian body. The neurons of the brain are postmitotic once differentiated and are unable to renew themselves. Thus, the brain is highly susceptible to any cellular damage that may occur with age.