A comparison of three different approaches to defining frailty in older patients with multiple myeloma

Isaacs, Ariel; Fiala, Mark A.; Tuchman, Sascha A.; Wildes, Tanya M.

doi:10.1016/j.jgo.2019.07.004

Cited by 21 publications

(17 citation statements)

References 33 publications

(45 reference statements)

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“…In concordance with other recently published data from multiple myeloma patients evaluated with different strategies to study frailty [ 17 , 18 ], we have found that the agreement among the different tools to evaluate PC is far from perfect in patients 65+ and, consequently, they are not readily interchangeable. This is not an unexpected finding since the various tools address different domains ( Table 2 ) and have different goals (LEE, life-expectancy estimation; GAH, plan B for geriatric assessment if CGA is not available; CGA, optimal geriatric evaluation).…”

Section: Discussionsupporting

confidence: 87%

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Ramos

González-Carmona

Porras-Guerra

et al. 2020

JPM

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Several societies have published recommendations for evaluating older adults with cancer in standard conditions. It is vital to assure a proper systematic patient condition evaluation, not only in the oldest (geriatric assessment) but in all adult patients. We have investigated the feasibility of a systematic evaluation of the general condition of all patients diagnosed with hematologic malignancies, and the degree of acceptance by the clinical team, in a prospective cohort of 182 consecutive adults, by using the ECOG performance status scale (ECOG, age 18 and over, 18+), Lee Index for Older Adults (LEE, 50+), Geriatric Assessment in Hematology (GAH, 65+), and the Comprehensive Geriatric Assessment (CGA, 75+). Clinical team acceptance was analyzed with a visual analogue scale, and the objective feasibility was calculated as the proportion of patients that could be finally evaluated with each tool. Acceptance was high, but the objective feasibility was progressively lower as the complexity of the different tools increased (ECOG 100%, LEE 99.4%, GAH 93.2%, and CGA 67.9%). LEE and GAH categories showed a weak concordance (Cohen’s Kappa 0.24) that was slight between LEE and CGA (Kappa 0.18). Unexpectedly, we found no significant association between the GAH and CGA categories (p = 0.16). We confirm that a systematic evaluation of all adult patients diagnosed with hematologic malignancies is feasible in daily practice by using an age-adapted approach. Direct comparisons among the different predictive tools in regard to patients’ tolerance to treatments of different intensities must be a priority research subject in the coming years.

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Section: Discussionsupporting

confidence: 87%

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Ramos

González-Carmona

Porras-Guerra

et al. 2020

JPM

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“…As the research evolves into frailty index mining, the key issues of validation before adoption include the need to compare to the accepted standard (IMWG FS), to test the prognostication prospectively, and to calibrate in a well-defined clinical trial populations before extending its predictability into real-world data is key. Some limited comparative studies and systematic reviews have been performed to date [32,44,45]. Salazar et al presented a critical evaluation in a systematic review and metaanalysis.…”

Section: Clinical Frailty Scoresmentioning

confidence: 99%

“…It provides evidence that the use of such scoring systems is valid but not which one to adopt in clinical practice. Isaacs et al [44] examined a comparison between IMWG FS, MCI and a cancer-based frailty deficit score (Carolina Frailty Score [46]), which as yet has not been tested in MM. Though this is to be applauded, the number of patients involved in the comparison is woefully inadequate to make a formal comparison valid.…”

Section: Clinical Frailty Scoresmentioning

confidence: 99%

Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network

et al. 2020

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As the treatment landscape continues to evolve towards the application of precision medicine in multiple myeloma (MM), there is a clear need to identify those patients who are at risk of not achieving the maximum benefit whilst exposed to the highest level of toxicity. This group of patients, defined as frail, is an unmet clinical need. However, how we define such a vulnerable group of patients with MM remains to be clarified. An integral aspect of this is to define the physiological age and capacity of patients with MM to deal with the burden of their disease and it's treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. A need to develop, test and validate clinical screening scores before their adoption into clinical practice is mandated. This position paper from the European Myeloma Network aims to review what is known about defining frailty in MM, and how we can advance this knowledge for the design of clinical trials and ultimately how we deliver treatment in the clinic.

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“…Another type of score is the revised Myeloma Comorbidity Index (R-MCI) based on the Karnofsky Performance Status (KPS), the presence of impaired lung and renal function, frailty, age, and cytogenetic abnormalities [5]. However, when they were compared in a prospective study, little agreement was found between these models [6]. It is difficult to fully appreciate the size of treatment efficacy, as elderly and frail patients are less likely to be included in clinical trials and may receive fewer novel agents, partly as a consequence of comorbidities, polypharmacy, and more rapid physiological decompensation associated with both disease-and treatment-related complications [7].…”

Section: Age and Vulnerabilitymentioning

confidence: 99%

Risk and Response-Adapted Treatment in Multiple Myeloma

Cazaubiel

Mulas

Montes

et al. 2020

Cancers

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Myeloma therapeutic strategies have been adapted to patients’ age and comorbidities for a long time. However, although cytogenetics and clinical presentations (plasmablastic cytology; extramedullary disease) are major prognostic factors, until recently, all patients received the same treatment whatever their initial risk. No strong evidence allows us to use a personalized treatment according to one cytogenetic abnormality in newly diagnosed myeloma. Retrospective studies showed a benefit of a double autologous transplant in high-risk cytogenetics according to the International Myeloma Working Group definition (t(4;14), t(14;16) or del(17p)). Moreover, this definition has to be updated since other independent abnormalities, namely gain 1q, del(1p32), and trisomies 5 or 21, as well as TP53 mutations, are also prognostic. Another very strong predictive tool is the response to treatment assessed by the evaluation of minimal residual disease (MRD). We are convinced that the time has come to use it to adapt the strategy to a dynamic risk. Many trials are ongoing to answer many questions: when and how should we adapt the therapy, its intensity and duration. Nevertheless, we also have to take into account the clinical outcome for one patient, especially adverse events affecting his or her quality of life and his or her preferences for continuous/fixed duration treatment.

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A comparison of three different approaches to defining frailty in older patients with multiple myeloma

Cited by 21 publications

References 33 publications

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network

Risk and Response-Adapted Treatment in Multiple Myeloma

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