Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report

• Published in: Blood Vol. 125; no. 13; pp. 2068 - 2074
• Main Authors: Palumbo, Antonio, Bringhen, Sara, Mateos, Maria-Victoria, Larocca, Alessandra, Facon, Thierry, Kumar, Shaji K., Offidani, Massimo, McCarthy, Philip, Evangelista, Andrea, Lonial, Sagar, Zweegman, Sonja, Musto, Pellegrino, Terpos, Evangelos, Belch, Andrew, Hajek, Roman, Ludwig, Heinz, Stewart, A. Keith, Moreau, Philippe, Anderson, Kenneth, Einsele, Hermann, Durie, Brian.G.M., Dimopoulos, Meletios A., Landgren, Ola, San Miguel, Jesus F., Richardson, Paul, Sonneveld, Pieter, Rajkumar, S. Vincent
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 26-03-2015; American Society of Hematology
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Clinical Trials and Observations; Clinical Trials as Topic; Cohort Studies; Frail Elderly; Geriatric Assessment; Humans; Multiple Myeloma - drug therapy; Multiple Myeloma - mortality; Prognosis; Withholding Treatment - statistics & numerical data
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2014-12-615187

We conducted a pooled analysis of 869 individual newly diagnosed elderly patient data from 3 prospective trials. At diagnosis, a geriatric assessment had been performed. An additive scoring system (range 0-5), based on age, comorbidities, and cognitive and physical conditions, was developed to identify 3 groups: fit (score = 0, 39%), intermediate fitness (score = 1, 31%), and frail (score ≥2, 30%). The 3-year overall survival was 84% in fit, 76% in intermediate-fitness (hazard ratio [HR], 1.61; P = .042), and 57% in frail (HR, 3.57; P < .001) patients. The cumulative incidence of grade ≥3 nonhematologic adverse events at 12 months was 22.2% in fit, 26.4% in intermediate-fitness (HR, 1.23; P = .217), and 34.0% in frail (HR, 1.74; P < .001) patients. The cumulative incidence of treatment discontinuation at 12 months was 16.5% in fit, 20.8% in intermediate-fitness (HR, 1.41; P = .052), and 31.2% in frail (HR, 2.21; P < .001) patients. Our frailty score predicts mortality and the risk of toxicity in elderly myeloma patients. The International Myeloma Working group proposes this score for the measurement of frailty in designing future clinical trials. These trials are registered at www.clinicaltrials.gov as #NCT01093196 (EMN01), #NCT01190787 (26866138MMY2069), and #NCT01346787 (IST-CAR-506).
•Elderly patients with myeloma are heterogeneous and assessment strategies are needed to define the frailty profile.•The proposed frailty score aims to better assess patients and provide them with more suitable therapies.