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‘Frailty Profile’ Predicts Survival and Toxicities Among Elderly Patients With Multiple Myeloma

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Key Points

  • A frailty score predicts mortality and toxicity risk in elderly patients with multiple myeloma and can be used to determine more suitable therapies.
  • At 3 years, overall survival was 84% among patients with a fit score, 76% among those with an intermediate fitness score, and 57% in frail patients.
  • At 12 months, the cumulative incidence of grade ≥ 3 nonhematologic adverse events was 34.0% for frail patients vs 26.4% for intermediate-fit and 22.2% for fit patients but did not differ significantly for hematologic events.

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. A geriatric assessment had been performed at diagnosis to assess comorbidities and cognitive and physical status.

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%), cardiopulmonary disease (10.4%), mild renal failure (7.4%), 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%).

Additive Scoring System

The investigators developed an additive scoring system (range 0–5), based on age, comorbidities, and cognitive and physical conditions to identify three groups: fit (score = 0, 39%), intermediate fitness (score = 1, 31%), and frail (score ≥ 2, 30%).

Three-year overall survival was 84% among patient 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, 95% CI = 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.

Useful in Determining Feasibility of Treatment

“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 over 65 years of age, 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 increased treatment-related toxicity and worse biology.”

Antonio Palumbo, MD, of the University of Torino, Italy, is the corresponding author of the Blood study.

The study was promoted by Fondazione Neoplasie Sangue Onlus, but no funding was received for this study. For full disclosures of the study authors, visit www.bloodjournal.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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