Frailty score helps predict risk for mortality, toxicity in elderly myeloma
A frailty score based on a geriatric assessment of age, comorbidities, and cognitive and physical status accurately predicted the risks for mortality and toxicity in elderly patients with newly diagnosed myeloma, according to study results.
“The assessment of frailty is an important, yet poorly defined metric in myeloma,” study author Sagar Lonial, MD, associate professor at the Winship Cancer Institute of Emory University and a HemOnc Today Editorial Board member, told HemOnc Today. “This study was undertaken to try and remove some of the subjectivity seen in evaluating older myeloma patients, and to create an objective measure of frailty. Importantly, in prospective trials, assessing benefit and toxicity based upon this objective frailty index will allow us to make specific observations and comments using a method more accurate than simple performance status assessment.”
Lonial and colleagues evaluated data from 869 patients enrolled on one of three prospective international trials. The median age of the population was 74 years, and 46% were aged older than 75 years.
Researchers developed a scoring system that included age, comorbidities, and cognitive and physical conditions. Risk scores ranged from 0 to 5 and corresponded with fit (score 0), intermediate-fitness (score 1) and frail (score ≥2) assessments.
More than one-third (39%) of patients had a score of 0, whereas 31% had a score of 1 and 30% had a score of 2 or higher.
Median follow-up was 18 months (interquartile range, 11-28).
Three-year OS rates were 84% among fit patients, 76% among intermediate-fitness patients, and 57% among frail patients.
The risk for mortality was greater in intermediate-fitness (HR = 1.61; 95% CI, 1.02-2.56) and frail (HR = 3.57; 95% CI, 2.37-5.39) patients compared with fit patients.
Grade 3 or worse non-hematologic adverse events at 12 months were more common in frail patients (34%; HR = 1.74; 95% CI, 1.28-2.38) and intermediate-fitness patients (26.4%; HR = 1.23; 95% CI, 0.89-1.71) compared with fit patients (22.2%). However, the cumulative incidence of grade 3 or worse hematologic adverse events at 12 months did not significantly correspond with the frailty score (fit, 38.4%; intermediate-fitness, 35.1%; frail, 32.2%).
Treatment discontinuation was more common in frail patients (31.2%; HR = 2.21; 95% CI, 1.57-3.09) and intermediate-fitness patients (20.8%; HR = 1.41; 95% CI, 1-2.01) compared with fit patients (16.5%).
“This study supports the systematic, prospective use of a geriatric assessment as an important additional tool in the clinical evaluation,” Lonial and colleagues concluded. “Our findings point out some relevant issues of patients’ functional and health status that have a prognostic importance similar to that of myeloma-related risk factors, such as International Staging System and chromosomal abnormalities. Prospective studies to validate our findings as well as a unique score reflecting both the reserve capacity of patients and established disease-specific risk factors are needed to provide comprehensive algorithms for therapeutic decision-making.” – by Alexandra Todak
For more information:
Sagar Lonial, MD, can be reached at Winship Cancer Institute of Emory University, 1365 Clifton Road NE, Bldg. C, Atlanta, Georgia 30322; email: firstname.lastname@example.org.
Disclosure: The researchers report research funding or honoraria from, as well as advisory committee, consultancy or speakers bureau roles with, Amgen, Bristol-Myers Squibb, Celgene, Gilead, Janssen, Merck Sharp & Dohme, Millennium, Novartis, Sanofi and several other pharmaceutical companies.