Validation of the Freiburg Comorbidity Index in 466 Multiple Myeloma Patients and Combination With the International Staging System Are Highly Predictive for Outcome

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

“…Therefore, an internal and external validation of postulated prognostic scores in unselected patient cohorts is necessary. 7,8,10,19 Since the IMWG score was tested, but not validated, the authors encouraged others to substantiate their findings. 4,6 In particular, "real world" patients were urged to be assessed, since the IMWG data was based on clinical trial patients who were stringently treated within trial protocols, where the frailest patients were excluded.…”

“…4 Indeed, prospective randomized studies constitute a good basis for the development of prognostic scores, since they meet all requirements postulated to be important. 2,[6][7][8] However, they bear the additional challenge that patients therein are selected according to strict inclusion criteria. Therefore, an internal and external validation of postulated prognostic scores in unselected patient cohorts is necessary.…”

“…[2][3][4][7][8][9][10] This typically occurs because multimorbidity and the interaction of various medications can complicate the treatment of patients, limit their physical condition and impair survival. 7,8,10 However, the global population is aging rapidly and the increasing number of elderly patients demands reliable tools to assess their vulnerability as expressed in chronic conditions and limitations in daily activities. Novel risk scores can either rely on MM tumor burden, as postulated with the combined use of the International Staging System (ISS), lactate dehydrogenase (LDH) and high-risk cytogenetics, 5,11 and/or the functional condition of patients, which is assessed worldwide.…”

“…[3][4][5][6][7][8] Moreover, elderly and frail patients are less frequently included in clinical trials and may receive fewer novel agents. [2][3][4][7][8][9][10] This typically occurs because multimorbidity and the interaction of various medications can complicate the treatment of patients, limit their physical condition and impair survival. 7,8,10 However, the global population is aging rapidly and the increasing number of elderly patients demands reliable tools to assess their vulnerability as expressed in chronic conditions and limitations in daily activities.…”

“…19 Herein, we prospectively and carefully assessed the IMWG score's impact on clinical outcome, and are the first who have thoroughly validated the IMWG baseline GA in a well-characterized external cohort. Since our prior analyses demonstrated that multivariate risk factors in MM patients include impaired renal function, lung function and Karnofsky performance status (KPS), 2,7,8,10,20 and that with a revised Myeloma Comorbidity Index (R-MCI), the inclusion of frailty, age and cytogenetics improves its prediction of fit, intermediate-fit and frail patients, 21 we included the R-MCI, CCI, HCT-CI and KF Index in this analysis. Our intention was validation, as diligently performed herein, and not the improvement of the IMWG score.…”