Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis

Salazar, Ana S.; Recinos, Luisa; Mian, Hira; Stoll, C; Simón, L; Sekhon, Subhjit; Colditz, Graham A.; Wildes, Tanya M.

doi:10.1016/j.clml.2019.04.014

Cited by 16 publications

(14 citation statements)

References 34 publications

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“…As a consequence of this seminal work several scores have been developed and tested in various populations (summarized in Table 1) and a systematic review was conducted by Salazar et al, with some notable omissions [32]. Subsequent scores were developed that did not included the functionality of ADL and IADL, often using PS instead, especially for retrospectively developed scores.…”

Section: Clinical Frailty Scoresmentioning

confidence: 99%

“…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%

“…Salazar et al presented a critical evaluation in a systematic review and metaanalysis. They identified seven studies, of which they only included three for the meta-analysis component [32]. However, they did not compare the scoring systems with IMWG FS rather they looked at the individual scoring system components and looked for efficacy of using frailty scoring in MM.…”

Section: Clinical Frailty Scoresmentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Clinical Frailty Scoresmentioning

confidence: 99%

Section: Clinical Frailty Scoresmentioning

confidence: 99%

Section: Clinical Frailty Scoresmentioning

confidence: 99%

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

et al. 2020

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“…The introduction of new agents has been reported to have prolonged survival in elderly patients [ 6 ]. Although age itself is not an obstacle for treatment, very elderly and frail patients are prone to experiencing treatment-related adverse events, leading to shorter survival [ 7 ]. Various frailty assessment tools, including the IMWG geriatric assessment tool, have been developed to predict outcomes concerning frail patients [ 8 ].…”

Section: Specific Considerations For Treatment Of Patients With Rrmmmentioning

confidence: 99%

Treatment of relapsed and refractory multiple myeloma

Lee

Kim

2020

Blood Res

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The therapeutic strategy for relapsed and refractory multiple myeloma (RRMM) integrates a holistic approach regarding patient, disease, and drug-related factors. Patient-related factors include age, frailty status, and underlying comorbidities, especially cardiovascular and renal diseases and peripheral neuropathies that affect tolerability to multiple drug combinations or transplantations. Disease-related factors encompass these multiple patient-related factors, particularly the aggressiveness of the disease and cytogenetics. Regarding drug-related factors, the approval of novel proteasome inhibitors (such as carfilzomib and ixazomib), immunomodulatory agents (such as pomalidomide), monoclonal antibodies (such as daratumumab and elotuzumab), and new classes of drugs increasingly makes the choice treatment more complex and necessitates a comprehensive summary and an update of the efficacy and toxicities of each antimyeloma drug and its combinations. Further, careful monitoring of the side effects and supportive care throughout the course of treatment are important to achieve better outcomes for patients with RRMM.

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“…For older adults with multiple myeloma (MM), assessment of frailty and function is essential in determining the intensity of the initial and subsequent MM regimens, which now range from two to four drugs for the majority of older patients who are ineligible for hematopoietic stem-cell transplant [ 4 , 5 ]. Older patients with MM identified as frail have a higher risk of treatment toxicity, higher rates of treatment discontinuation, and higher mortality [ 6 , 7 , 8 , 9 ]. Diagnosing frailty not only aids in MM treatment selection, but also identifies aging-related deficits that can be addressed and optimized alongside MM treatment [ 6 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Contemporary Analysis of Electronic Frailty Measurement in Older Adults with Multiple Myeloma Treated in the National US Veterans Affairs Healthcare System

DuMontier

Fillmore

Yildirim

et al. 2021

Cancers

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Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic Veterans Affairs Frailty Index (VA-FI-10)—developed and validated to measure frailty in the national United States (US) VA Healthcare System—to estimate the prevalence and impact of frailty in older US veterans newly treated for multiple myeloma (MM) with contemporary therapies. We designed a retrospective cohort study of 4924 transplant-ineligible veterans aged ≥ 65 years initiating MM therapy within VA from 2004 to 2017. Initial MM therapy was measured using inpatient and outpatient treatment codes from pharmacy data in the VA Corporate Data Warehouse. In total, 3477 veterans (70.6%) were classified as frail (VA-FI-10 > 0.2), with 1510 (30.7%) mildly frail (VA-FI-10 > 0.2–0.3), 1105 (22.4%) moderately frail (VA-FI-10 > 0.3–0.4), and 862 (17.5%) severely frail (VA-FI-10 > 0.4). Survival and time to hospitalization decreased with increasing VA-FI-10 severity (log-rank p-value < 0.001); the VA-FI-10 predicted mortality and hospitalizations independently of age, sociodemographic variables, and measures of disease risk. Varying data sources and assessment periods reclassified frailty severity for a substantial portion of veterans but did not substantially affect VA-FI-10’s association with mortality. Our study supports use of the VA-FI-10 in future research involving older veterans with MM and provides insights into its potential use in identifying frailty in clinical practice.

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Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis

Cited by 16 publications

References 34 publications

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

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

Treatment of relapsed and refractory multiple myeloma

Contemporary Analysis of Electronic Frailty Measurement in Older Adults with Multiple Myeloma Treated in the National US Veterans Affairs Healthcare System

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