Abstract
Objectives
We compared the performance of two frailty scoring systems in predicting survival
among older patients with multiple myeloma: the International Myeloma Working Group
(IMWG) frailty score (which includes age), and the Fried model for frailty (which
does not).
Methods
From 2015 to 2018, all patients aged 75 years and older presenting at our institution
with a diagnosis of multiple myeloma were approached for a frailty screening assessment.
We first categorized patients' frailty using the Fried model. Then, using available
deficit measures, we reclassified frailty using the IMWG approach. We compared the
performance of the IMWG strategy to the Fried model in terms of association with overall
survival.
Results
Of the 98 (92%) patients who consented to a baseline frailty assessment, we found
57% discordance among frailty classification between the two scoring systems. Using
the IMWG strategy, 9% of the cohort was “fit,” 29% “intermediate-fit,” and 62% “frail.”
Using the Fried model, 29% of the cohort was “robust,” 52% “pre-frail,” and 19% “frail.”
Frailty category in the Fried model was predictive of overall survival among our cohort,
while frailty category in the IMWG strategy was not (log-rank p = 0.04 vs. 0.34).
Conclusion
Among our cohort of older patients with myeloma (aged 75 and higher), the Fried model
appears to be a better predictor of survival compared to the IMWG strategy. These
results suggest that using age as a criterion to identify frailty in older patients
with multiple myeloma may limit treatment options for the functionally vigorous.
Keywords
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References
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- International society of geriatric oncology consensus on geriatric assessment in older patients with cancer.J Clin Oncol. 2014; 32: 2595-2603
- Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report.Blood. 2015; 125: 2068-2074
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores.Haematologica. 2016; 101: 1110-1119
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56 (M146–56)
- Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70.J Am Geriatr Soc. 2006; 54: 975-979
- Patient-centered practice in elderly myeloma patients: an overview and consensus from the European Myeloma Network (EMN).Leukemia. 2018; 32: 1697-1712
- A concise revised myeloma comorbidity index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients.Haematologica. 2017; 102: 910-921
- Development of a medicare health outcomes survey deficit-accumulation frailty index and its application to older patients with newly diagnosed multiple myeloma.JCO Clin Cancer Informa. 2018; : 1-13
Article info
Publication history
Published online: November 21, 2018
Accepted:
October 12,
2018
Received in revised form:
September 27,
2018
Received:
September 5,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
