Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients

Bonello, Francesca; Boccadoro, Mario; Larocca, Alessandra

doi:10.3390/cancers12113106

Cited by 13 publications

(14 citation statements)

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“…Also, EM markedly decreased since 2009, which can be explained by the superior activity and better tolerability of newer regimens, as well as improvements in supportive care. In addition, an increased use of dose-adapted regimens in intermediate-fit and frail patients may also have contributed to reduced EM over time [ 9 – 11 ]. The importance of dose on clinical outcomes has been clearly demonstrated for dexamethasone, with a randomized phase 3 study showing that lenalidomide plus low-dose dexamethasone resulted in lower toxicity, including infections and venous thromboembolic events, which translated into improved short-term survival, compared to lenalidomide plus high-dose dexamethasone in patients with newly diagnosed MM [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study

et al. 2021

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Identification of risk factors for early mortality (EM) in multiple myeloma (MM) patients may contribute to different therapeutic approaches in patients at risk for EM. This population-based study aimed to assess trends in EM and risk factors for EM among MM patients diagnosed in the Netherlands. All MM patients, newly diagnosed between 1989 and 2018, were identified in the Netherlands Cancer Registry. Patients were categorized into three calendar periods (1989–1998, 1999–2008, 2009–2018) and into five age groups (≤65, 66–70, 71–75, 76–80, >80 years). EM was defined as death by any cause ≤180 days post-diagnosis. We included 28,328 MM patients (median age 70 years; 55% males). EM decreased from 22% for patients diagnosed in 1989–1998 to 13% for patients diagnosed in 2009–2018 (P < 0.01) and this decrease was observed among all age groups. Exact causes of death could not be elucidated. Besides patient’s age, we found that features related to a more aggressive disease presentation, and patient characteristics reflecting patients’ physical condition were predictive of EM. In summary, EM decreased from 1999 onwards. Nevertheless, EM remains high, especially for patients aged >70 years. Therefore, novel strategies should be explored to improve the outcome of patients at risk for EM.

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Section: Discussionmentioning

confidence: 99%

Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study

et al. 2021

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“…The IMWG frailty score currently represents the gold standard for risk stratification, and its use to guide therapeutic decisions in elderly patients is recommended in clinical practice ( 51 ). Aside from the strengths and weaknesses of the various models proposed, the common goal is to identify those patients who are able to receive full-dose regimens aimed at disease remission and those in whom avoiding toxicity and preserving quality of life should be the main treatment goals ( 52 , 53 ). Although it is now widely recognized that chronological age alone is not sufficient to guide therapeutic decisions, patients aged ≥80 years (who, according to the IMWG frailty score, were determined to be frail by age only), similarly to patients who were determined to be frail due to comorbidities or functional impairment, showed a worse OS (median OS 43 vs. 77 months, HR 1.51, p=0.002) and a higher rate of treatment discontinuation (HR 2.34, p<0.001), as compared with non-frail patients ( 54 ).…”

Section: Risk Stratification Before Starting Treatmentmentioning

confidence: 99%

Risk Stratification Before and During Treatment in Newly Diagnosed Multiple Myeloma: From Clinical Trials to the Real-World Setting

2022

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Multiple Myeloma (MM) is a hematologic malignancy characterized by a wide clinical and biological heterogeneity leading to different patient outcomes. Various prognostic tools to stratify newly diagnosed (ND)MM patients into different risk groups have been proposed. At baseline, the standard-of-care prognostic score is the Revised International Staging System (R-ISS), which stratifies patients according to widely available serum markers (i.e., albumin, β 2-microglobulin, lactate dehydrogenase) and high-risk cytogenetic abnormalities detected by fluorescence in situ hybridization. Though this score clearly identifies a low-risk and a high-risk population, the majority of patients are categorized as at “intermediate risk”. Although new prognostic factors identified through molecular assays (e.g., gene expression profiling, next-generation sequencing) are now available and may improve risk stratification, the majority of them need specialized centers and bioinformatic expertise that may preclude their broad application in the real-world setting. In the last years, new tools to monitor response and measurable residual disease (MRD) with very high sensitivity after the start of treatment have been developed. MRD analyses both inside and outside the bone marrow have a strong prognostic impact, and the achievement of MRD negativity may counterbalance the high-risk behavior identified at baseline. All these techniques have been developed in clinical trials. However, their efficient application in real-world clinical practice and their potential role to guide treatment-decision making are still open issues. This mini review will cover currently known prognostic factors identified before and during first-line treatment, with a particular focus on their potential applications in real-world clinical practice.

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“…61 Recommendations have been made as to which treatment modality patients should be allocated after having been assessed by the IMWG-FI. 80,81 There are other multi-parameter assessments available for multiple myeloma (eg, the Revised Myeloma Comorbidity Index) [82][83][84] that are validated for prognostication, but their usage for treatment allocation remains to be clarified.…”

Section: Entity-specific Toolsmentioning

confidence: 99%

Frailty assessment in the care of older people with haematological malignancies

Goede

Neuendorff

Schulz

et al. 2021

The Lancet Healthy Longevity

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Diagnostic and Therapeutic Challenges in the Management of Intermediate and Frail Elderly Multiple Myeloma Patients

Cited by 13 publications

References 77 publications

Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study

Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study

Risk Stratification Before and During Treatment in Newly Diagnosed Multiple Myeloma: From Clinical Trials to the Real-World Setting

Frailty assessment in the care of older people with haematological malignancies

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