Frailty assessment in the care of older people with haematological malignancies

Goede, Valentin; Neuendorff, Nina Rosa; Schulz, Ralf-Joachim; Hormigo, Ana-Isabel; Martínez-Peromingo, Francisco Javier

doi:10.1016/s2666-7568(21)00184-7

Cited by 27 publications

(17 citation statements)

References 91 publications

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“…One crucial aspect for MM patients and physicians is the individual selection of the initial (and subsequent) treatment and its intensity. 7 , 33 Our message is that we apply evidence generated from clinical trials that rarely include old or frail patients to treat such patients without knowledge of the need for modifications of the drugs used, the dosing or schedule. Although our study population received first-line MM treatment with dose modifications according to best clinical judgment and a prospective frailty assessment was performed, the frailty assessment was not used for decision making.…”

Section: Discussionmentioning

confidence: 99%

“… 21 An understandable request is that these risk-assessments should not be time-consuming and prospectively performed. 7 Both, the R-MCI and IMWG-frailty index offer online tools for their automatic calculation.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Albeit patient assessment, via age, Karnofsky Performance Status (KPS), comorbidities, patient-history and -examination, is performed, MM patients' actual constitution and fitness can be over-or underestimated. [5][6][7][8] Additionally, inclusion in clinical trials is especially rare in elderly patients over the age of 70 years. 5,6 This suggests that more objective tools may assist physicians to find most suitable treatment regimens and to adapt dose intensity for elderly and/or MM-stricken patients.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13] However, therapy decisions are often made without an objective fitness assessment yet. 7,14,15 In recent years, MM-specific risk scores (e.g. International Myeloma Working Group (IMWG)-frailty score, Revised-Myeloma Comorbidity Index (R-MCI), Mayo-risk score, UK Myeloma Research Alliance Risk Profile) were developed to assist in this unsolved matter.…”

Section: Introductionmentioning

confidence: 99%

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An objective assessment in newly diagnosed multiple myeloma to avoid treatment complications and strengthen therapy adherence

et al. 2022

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In heterogeneous multiple myeloma (MM) patients treatment decisions are challenging. The hypothesis was that adaptation of treatment intensity (dose reduction [DR] vs. none) according to an objective risk score (Revised-Myeloma Comorbidity Index [R-MCI]) rather than physician judgement alone may improve therapy efficacy and avoid toxicities. We performed this study in 250 consecutive MM patients who underwent a prospective fitness assessment at our center, yet received induction protocols based on physicians’ judgement. DR, serious adverse events (SAEs), response, progression free- (PFS) and overall survival (OS) were compared in fitness (fit, intermediate-fit, frail), age (

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An objective assessment in newly diagnosed multiple myeloma to avoid treatment complications and strengthen therapy adherence

et al. 2022

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“…Ältere Menschen mit hämatologischen Neoplasien haben vielfach eine deutlich schlechtere Therapieverträglichkeit sowie ein schlechteres Gesamtüberleben [1]. Neben diversen biologischen Risiken der hämatologischen Grunderkrankung sind Komorbiditäten, geriatrische Defizite und eine allgemeine Gebrechlichkeit hierfür ursächlich [1]. Inwieweit ein geriatrisches Ko-Management die Prognose und Therapieverträglichkeit verbessern kann, bleibt bislang unklar.…”

Section: Transfer In Die Praxis Von Dr Med Nina Rosa Neuendorff (Essen)unclassified

Geriatrisches Ko-Management in der Hämatologie: Bloß nicht entmutigen lassen!

Neuendorff¹

2022

Kompass Onkol

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We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients aged ≥75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA, USA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficit-accumulation approaches, were randomized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end-of-life (EOL) goals-of-care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consultation plus standard care (n = 60) or standard care alone (n = 100). The median age of the patients was 80.4 years (standard deviation = 4.2). Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at 1 year compared to standard care (difference: 2.9%, 95% confidence interval: –9.5% to 15.2%, P = 0.65), and did not significantly reduce the incidence of emergency department visits, hospital admissions, or days in hospital. Consultation did improve the odds of having EOL goals-of-care discussions (odds ratio = 3.12, 95% confidence interval: 1.03 to 9.41) and was valued by surveyed hematologic-oncology clinicians, with 62.9%–88.2% of them rating consultation as useful in the management of several geriatric domains.

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Brexucabtagene autoleucel for relapsed or refractory mantle cell lymphoma in the United Kingdom: A real‐world intention‐to‐treat analysis

O'Reilly,

Wilson,

Burns

et al. 2024

HemaSphere

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Brexucabtagene autoleucel (brexu‐cel) is an autologous CD19 CAR T‐cell product, approved for relapsed/refractory (r/r) mantle cell lymphoma (MCL). In ZUMA‐2, brexu‐cel demonstrated impressive responses in patients failing ≥2 lines, including a bruton's tyrosine kinase inhibitor, with an overall and complete response rate of 93% and 67%, respectively. Here, we report our real‐world intention‐to‐treat (ITT) outcomes for brexu‐cel in consecutive, prospectively approved patients, from 12 institutions in the United Kingdom between February 2021 and June 2023, with a focus on feasibility, efficacy, and tolerability. Of 119 approved, 104 underwent leukapheresis and 83 received a brexu‐cel infusion. Progressive disease (PD) and/or manufacturing (MF) were the most common reasons for failure to reach harvest and/or infusion. For infused patients, best overall and complete response rates were 87% and 81%, respectively. At a median follow‐up of 13.3 months, median progression‐free survival (PFS) for infused patients was 21 months (10.1–NA) with a 6‐ and 12‐month PFS of 82% (95% confidence interval [CI], 71–89) and 62% (95% CI, 49–73), respectively. ≥Grade 3 cytokine release syndrome and neurotoxicity occurred in 12% and 22%, respectively. On multivariate analysis, inferior PFS was associated with male sex, bulky disease, ECOG PS > 1 and previous MF. Cumulative incidence of non‐relapse mortality (NRM) was 6%, 15%, and 25% at 6, 12, and 24 months, respectively, and mostly attributable to infection. Outcomes for infused patients in the UK are comparable to ZUMA‐2 and other real‐world reports. However, ITT analysis highlights a significant dropout due to PD and/or MF. NRM events warrant further attention.

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Frailty assessment in the care of older people with haematological malignancies

Cited by 27 publications

References 91 publications

An objective assessment in newly diagnosed multiple myeloma to avoid treatment complications and strengthen therapy adherence

An objective assessment in newly diagnosed multiple myeloma to avoid treatment complications and strengthen therapy adherence

Geriatrisches Ko-Management in der Hämatologie: Bloß nicht entmutigen lassen!

Brexucabtagene autoleucel for relapsed or refractory mantle cell lymphoma in the United Kingdom: A real‐world intention‐to‐treat analysis

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