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Geriatric assessment predicts survival and toxicities in elderly myeloma: an International Myeloma Working Group report

Antonio Palumbo, Sara Bringhen, Maria-Victoria Mateos, Alessandra Larocca, Thierry Facon, Shaji K. Kumar, Massimo Offidani, Philip McCarthy, Andrea Evangelista, Sagar Lonial, Sonja Zweegman, Pellegrino Musto, Evangelos Terpos, Andrew Belch, Roman Hajek, Heinz Ludwig, A. Keith Stewart, Philippe Moreau, Kenneth Anderson, Herman Einsele, Brian G.M. Durie, Meletios A. Dimopoulos, Ola Landgren, Jesus F. San Miguel, Paul Richardson, Pieter Sonneveld and S. Vincent Rajkumar
This article has an Erratum 127(9):1213
This article has an Erratum 128(7):1020

Key points

  • Elderly patients with myeloma are heterogeneous and assessment strategies are needed to define the frailty profile.

  • The proposed frailty score aims to better assess patients and provide them with more suitable therapies.

Abstract

We conducted a pooled analysis of 869 individual newly diagnosed elderly patient data from 3 prospective international trials. At diagnosis, a geriatric assessment had been performed to assess comorbidities, cognitive and physical status. An additive scoring system (range 0-5), based on age, comorbidities, cognitive and physical conditions, was developed to identify 3 groups: fit (score=0, 39%); intermediate-fitness (score=1, 31%), and frail (score≥2, 30%). The 3-year overall survival was 84% in fit patients, 76% in intermediate-fitness patients (HR 1.61, 95%CI 1.02-2.56, p=0.042) and 57% in frail patients (HR 3.57 CI 95% 2.37-5.39, p<0.001). The cumulative incidence of grade ≥3 non-hematologic adverse events at 12 months was 22.2% in fit, 26.4% in intermediate-fitness (HR 1.23, 95%CI 0.89-1.71; p 0.217) and 34.0% (HR 1.74, 95%CI 1.28-2.38; p<0.001) in frail patients. The cumulative incidence of treatment discontinuation at 12 months was 16.5% in fit, 20.8% in intermediate-fitness (HR 1.41, 95%CI 1.00-2.01, p=0.052) and 31.2% (HR 2.21, 95%CI 1.57-3.09; p<0.001) in frail patients. Our frailty score predicts mortality and the risk of toxicity in elderly myeloma patients. The International Myeloma Working group proposes this score for the measurement of frailty in designing future clinical trials. These trials are registered to www.clinicaltrials.gov as NCT01093136 (EMN01), NCT01190787 (26866138MMY2069), and NCT01346787 (IST-CAR-506).

  • Submitted December 3, 2014.
  • Accepted January 13, 2015.