A frailty score predicts mortality and the risk of toxicity in elderly patients with multiple myeloma and can be used to determine more suitable therapies for these patients, the International Myeloma Working Group reported in Blood.
“Chronologic age, performance status, and physician’s clinical judgment are not sufficient to characterize the frail population,” the authors stated. Geriatric assessment “is a more sensitive predictor of clinical outcomes, and the proposed score may be adopted as a valid new standard to evaluate patients’ frailty. It could be used in everyday clinical practice as well as in the context of research to ensure an adequate representation of elderly patients and to allow more precise cross-trial comparisons.”
The score is based on a pooled analysis of data from 869 newly diagnosed elderly patients from three prospective international trials. “At diagnosis, a geriatric assessment had been performed to assess comorbidities, cognitive [status], and physical status,” the authors explained.
The median age of the patients was 74 years, and 46% were older than 75 years. The most frequent comorbidities were diabetes without organ damage (13.2%), mild renal failure (7.4%), cardiopulmonary disease (10.4%), and peripheral vascular disease (5.8%). The most frequent abnormal parameters for activities of daily living were related to transportation (38.0%), housekeeping (37.3%), shopping (33.9%), laundry (31%), independence in bathing (19.6%), transferring (13.7%), and dressing (12.1%).
“An additive scoring system (range, 0–5), based on age, comorbidities, cognitive and physical conditions, was developed to identify three groups: fit (score = 0, 39%); intermediate-fitness (score = 1, 31%), and frail (score ≥ 2, 30%),” the investigators reported.
At 3 years, 3-year overall survival was 84% among patients with a fit score, 76% among those with an intermediate-fitness score (hazard ratio [HR], 1.61, 95% confidence interval [CI], 1.02–2.56, P = .042), and 57% in frail patients (HR, 3.57, CI 95%, 2.37–5.39, P < .001). The cumulative incidence of grade ≥ 3 nonhematologic adverse events at 12 months was greater among frail patients (34.0% vs 26.4% for intermediate-fit and 22.2% for fit patients). The risk of grade > 3 hematologic adverse events was not significantly different among the three groups.
“This analysis showed that a frailty score that combines age, functional status, and comorbidities can predict survival and toxicity and is useful to determine the feasibility of a treatment regimen,” the authors concluded. “The frailty profile was associated with an increased risk of death, progression, nonhematologic adverse events, and treatment discontinuation,” the authors noted.
Currently, more than 60% of multiple myeloma diagnoses and nearly 75% of deaths occur in patients older than age 65, according to the International Myeloma Working Group. Although novel agents have substantially improved outcomes, the authors noted, “patients over 70 years benefit less from new treatments, probably due to an increased treatment-related toxicity and worse biology.” ■
Palumbo A, et al: Blood 125:2068-2074, 2015.