Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores

Engelhardt, Monika; Dold, Sandra Maria; Ihorst, Gabriele; Zober, Alexander; Möller, Mandy; Reinhardt, Heike; Hieke, Stefanie; Schumacher, Martin; Wäsch, Ralph

doi:10.3324/haematol.2016.148189

Cited by 154 publications

(249 citation statements)

References 43 publications

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“…Geriatric assessment and comorbidity scores will be helpful to encourage autologous transplantation in many MM older patients. 37,38 The low rate of second primary malignancies following tandem MEL140 in comparison to that in the published literature 39 is noteworthy and could be related to the limited first-line treatment in the study population.…”

Section: Induction Phase Mobilization 1 Mel 140 2 Mel 140 Inductionmentioning

confidence: 82%

Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial

Straka¹,

Liebisch

Salwender

et al. 2016

Haematologica

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A utologous transplantation is controversial for older patients with multiple myeloma. The role of age-adjusted high-dose melphalan and the impact of induction chemotherapy cycles is still unclear. A total of 434 patients aged 60-70 years were randomly assigned to 4 cycles of standard anthracycline-based induction chemotherapy or no induction. For all patients, double autologous transplantation after melphalan 140 mg/m 2 (MEL140) was planned. The primary end point was progression-free survival. Of 420 eligible patients, 85% received a first transplant and 69% completed double transplantation. Treatment duration was short with a median of 7.7 months with induction chemotherapy cycles and 4.6 months without induction. On an intention-to-treat basis, median progression-free survival with induction chemotherapy cycles (207 patients) was 21.4 months versus 20.0 months with no induction cycles (213 patients) (hazard ratio 1.04, 95% confidence interval 0.84-1.28; P=0.36). Per protocol, progression-free survival was 23.7 months versus 23.0 months (P=0.28). Patients aged 65 years or over (55%) did not have an inferior outcome. Patients with low-risk cytogenetics [absence of del17p13, t(4;14) and 1q21 gains] showed a favorable overall survival and included the patients with sustained first remission. MEL140 was associated with a low rate of severe mucositis (10%) and treatment-related deaths (1%). Based on hazard ratio, the short treatment arm consisting of mobilization chemotherapy and tandem MEL140 achieved 96% of the progression-free survival, demonstrating its value as an independent component of therapy in older patients with multiple myeloma who are considered fit for autologous transplantation. (clinicaltrials.gov identifier: 02288741)

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Section: Induction Phase Mobilization 1 Mel 140 2 Mel 140 Inductionmentioning

confidence: 82%

Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial

Straka¹,

Liebisch

Salwender

et al. 2016

Haematologica

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show abstract

“…13 Specifically, the Freiburg team has proposed a revised Myeloma Comorbidity Index for future frailty measurements which could help to identify those patients fit enough to undergo stem cell transplantation. 33 In conclusion, these prospective multicenter results indicate that ASCT is a safe and effective mode of treatment for elderly and fit MM patients in the present era of novel induction agents. One may note that patients over 70 years of age did not have a worse prognosis.…”

mentioning

confidence: 98%

Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study

et al. 2016

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T he feasibility and efficacy of high-dose melphalan followed by autologous hematopoietic stem cell transplantation in newly diagnosed elderly patients with multiple myeloma was analyzed prospectively. Fifty-six multiple myeloma patients, aged 65 years or over, from 6 French centers were studied. The induction therapy was bortezomib-based in combination with dexamethasone and either thalidomide, cyclophosphamide or lenalidomide, for 4-6 cycles. Peripheral blood stem cells were collected after high-dose cyclophosphamide plus G-CSF or G-CSF alone, with plerixafor if needed. The conditioning regimen consisted of melphalan at 140 mg/m² in 18 patients (36%) and 200 mg/m 2 in 32 (64%). Three months post autologous hematopoietic stem cell transplantation, a 2-month consolidation phase with either lenalidomide plus dexamethasone or bortezomibbased combination therapy was allowed, but maintenance treatment was not given. All but 6 patients underwent autologous hematopoietic stem cell transplantation and 3 had tandem transplantations. The treatment-related mortality was 0% at 100 days post transplantation. Sixtyeight percent received consolidation therapy following transplantation. The best response achieved was 40% complete response, 36% very good partial response, and 18% partial response. After a median follow up of 21 months (range 6-31), the estimated progression-free and overall survival rates at two years were 76% [95%CI: (61.6-94.1)] and 88% [95%CI: (76.7-100)], respectively. The higher dose of melphalan (200 mg/m 2 ) afforded superior progression-free and overall survival rates. This prospective study provides evidence for the safety and efficacy of autologous hematopoietic stem cell transplantation as a first-line treatment approach in elderly multiple myeloma patients. (clinicaltrials.gov identifier: 01671826)

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“…Nevertheless, since this was a non-randomized study and patients were selected (e.g., those with MEL200 were fitter and not comparable to all newly diagnosed elderly MM patients), objective, prospective and proficiently performed fitness tools might be of benefit before intensive treatment is induced, the more so, since patients and physicians fitness ratings are not as objective as defined tests and scores. 1,18,19 However, geriatric tests have been criticized as being time-consuming, and few data as yet show a correlation between geriatric assessment and clinical outcome. 5 We and others have, however, shown that one can get a straightforward score and homepage help to swiftly assess MM patients within 1-2 minutes, [18][19][20] which can be used before intensive therapeutic interventions, such as ASCT.…”

mentioning

confidence: 99%

Autotransplants in older multiple myeloma patients: hype or hope in the era of novel agents?

et al. 2016

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Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores

Cited by 154 publications

References 43 publications

Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial

Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial

Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study

Autotransplants in older multiple myeloma patients: hype or hope in the era of novel agents?

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