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Abstract
The number of elderly people is rapidly growing, and the proportion of elderly patients with multiple myeloma (MM) continues to increase. This study aimed to develop a frailty assessment tool based on clinical data and to estimate its feasibility in elderly patients with MM. This study analyzed data from 728 elderly transplant-ineligible patients with newly diagnosed MM who were treated between January 2010 and October 2019. Our clinical frailty index included age (< 75, and ≥ 75 years), Charlson comorbidity index (CCI; < 3 and ≥ 3), and Eastern Cooperative Oncology Group performance status score (ECOG score; 0, 1–2, and ≥ 3). Patients were classified as fit, intermediate, or frail if they had a score of 0, 1, or ≥ 2, respectively. The overall survival rates differed significantly according to frailty (fit vs. intermediate: hazard ratio [HR] = 2.41; 95% confidence interval [CI] = 1.43–4.06; P = 0.001; fit vs. frail: HR = 4.61; 95% CI = 2.74–7.77; P < 0.001 and intermediate vs. frail: HR = 1.91, 95% CI = 1.49–2.45, P < 0.001, respectively). The frail had significantly shorter EFS compared with the fit and intermediate group in our frailty index (fit vs. intermediate: HR = 1.34, 95% CI = 0.92–1.96, P = 0.132; fit vs. frail: HR = 2.06, 95% CI = 1.40–3.02, P < 0.001; and intermediate vs. frail: HR = 1.53, 95% CI = 1.22–1.92, P < 0.001, respectively). The new clinical frailty index, which is based on age, CCI, and ECOG PS, can easily assess frailty in elderly patients with MM and can be helpful in predicting survival outcomes in real world clinical setting.
Highlights
The number of elderly people is rapidly growing, and the proportion of elderly patients with multiple myeloma (MM) continues to increase[1,2]
We demonstrate a newly developed frailty index in a large number of patients who were relatively uniformly treated with 76% having received bortezomib based therapy as initial treatment
This frailty index is based on age, Charlson comorbidity index (CCI), and Eastern Cooperative Oncology Group performance status (ECOG PS) that can be used to classify frail patients and predict survival outcomes in clinical practice
Summary
The number of elderly people is rapidly growing, and the proportion of elderly patients with multiple myeloma (MM) continues to increase[1,2]. Karnofsky performance status, frailty, and age were determined as significant risk factors affecting overall survival (OS). These were combined in a weighted R-MCI, allowing for the identification of low (≤ 3 [n = 247, 30.8%]), intermediate (4–6 [n = 446, 55.7%]), and high-risk patients (> 6 [n = 108, 13.5%]). There is an unmet need for a frailty assessment tool that is easy to use for elderly frail patients with MM in the real world clinical setting. This study aimed to develop a new clinical frailty index and to estimate its feasibility based on readily available and routinely collected clinical data that could predict OS in elderly transplant-ineligible patients with MM in a real world setting
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