A Multicenter Prospective Study for Validation of the Korean Simple Geriatric Assessment Tool in Elderly Patients with Multiple Myeloma

Abstract

Purpose Frailty is a multidimensional state of diminished reserve (energy, physical ability, cognition and health) which gives rise to vulnerability to cancer treatment. Geriatric assessment (GA) with management should be integrated into the clinical care of older patients with multiple myeloma (MM). with ageing-related conditions. The purpose of this study was to prospectively validate the Korean Cancer Study Group Geriatric Score (KG)-7, a simplified frailty assessment tool, in older patients with multiple myeloma (MM) planned to undergo first-line chemotherapy. Materials and Methods The study included 95 newly diagnosed MM patients aged 70 years or older. Participants answered the KG-7 questionnaire before undergoing International Myeloma Working Group (IMWG) frailty score and first-line bortezomib- and/or lenalidomide- based chemotherapy. KG-7 scores ranged from 0 to 7, and higher scores indicated better conditions. Results The median age was 77 years and 50.5% of patients were older than 75 years. Fifteen patients (15.8%) had an ADL score ≤ 4, 24 (25.3%) an IADL score ≤ 5, and 19 (20.0%) a CCI ≥ 2. Based on the < 5 cut-off value of KG-7 for frail group, frail group was shown in 29 (30.5%). There was the negative correlation between KG-7 and IMWG frailty score (Pearson correlation, 0.547; P < 0.001). The cumulative incidence of grade ≥ 3 non-hematologic adverse events was 27.3% in non-frail and 48.3% in frail patients (HR, 2.5; P = 0.046). There was no significant difference between the two groups of KG-7 with regard to grade ≥ 3 hematological toxicity and dose modification at cycle one. There was no significant difference between the two groups (frail versus non-frail) in PFS (hazard ratio [HR] = 1.37; 95% CI = 0.52-3.65; P = 0.525) and OS (HR = 1.85; 95% CI 0.52-6.58, P = 0.341), which was attributed to the short FU period of 11.6 months. Interpretation Despite the interim analysis, KG-7 appears to be an easy-to-define prediction model for defining the vulnerable patients with MM. Whether KG-7 is helpful in predicting survival outcome requires longer follow-up.