Structured assessment of frailty in multiple myeloma as a paradigm of individualized treatment algorithms in cancer patients at advanced age

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

“…One such study highlighted the use of stepping, walking and PAB parameters (sedentary and moderate-to-vigorous activity) in detecting pre-frailty [41]. Lastly, the use of the CCI has been core to many of the frailty scoring systems, though was not designed to be utilised in this setting in MM [20,33,35,42]. Furthermore, given the average age of patients with MM and their documented multi-morbidity, this clinical setting represents the epitome of cluster CT clinical trials, RW real world, PS performance status, ADL activities of daily living, IADL independent activities of daily living.…”

“…Engelhardt et al devised a myeloma-specific comorbidity system that included 13 points of disease and organ dysfunction, in a similar design to the haematopoietic cell transplantation-specific comorbidity index [43], with the MCI preforming best in the dataset tested [20]. Further work can be useful in this regard [35,42].…”

“…NCRI Myeloma XI, the largest upfront trial in newly diagnosed MM, had a median age of 74 in the TNE cohort though only 13.2% were older than 80 years compared with the population rate of MM in the UK where 54.8% are older than 80 years of age [7]. As such it is clear that any clinical scoring system or biomarker, whether prognostic or predictive needs to be evaluated in a realworld population if the true impact on everyday clinical practice is to be measured [20,33,35,42,70].…”

Maintenance therapy in transplant ineligible adults with newly‐diagnosed multiple myeloma: A systematic review and meta‐analysis

“…While this approach may lead to superior disease control, certain patients may be at higher risk of cumulative toxicity, significant treatment burden, and impaired quality of life 13 . This may be particularly important among older transplant ineligible patients, who do not only suffer from symptoms related to their MM, but also have underlying co‐morbidities, and co‐existing frailty 30,31 . Additionally, the perceived benefit of continuous therapy is often challenging to consolidate due to the heterogeneity of study designs and use of different induction regimens within a trial, making it difficult to formulate conclusions.…”

Validation of the revised myeloma comorbidity index and other comorbidity scores in a multicenter German study group multiple myeloma trial

“…3,4 Therefore, with the growing number of elderly (and frail) MM patients, reliable tools to assess patients' vulnerability, as expressed in chronic conditions and limitations in daily activity, are wanted to guide through today's multiple possible therapeutic options. 5,6 Historically, treatment decisions in symptomatic MM patients were age-based. Ideally today, disease biology and fitness, including patients' Karnofsky Performance-(KPS)-or Eastern Co-operative Oncology Group performance status (ECOG-PS) are considered when assessing therapeutic options.…”