Frailty Score Predicts Survival in Elderly Myeloma Patients

The International Myeloma Working Group has developed a scoring system that measured frailty in elderly patients with multiple myeloma and was able to accurately predict mortality and risk of toxicity. 

“Chronologic age, performance status, and physician’s clinical judgment are not sufficient to characterize the frail population,” wrote Antonio Palumbo, MD, of the University of Torino, Italy, and colleagues in Blood. “The geriatric assessment is a more sensitive predictor of clinical outcomes, and the proposed score may be adopted as a valid new standard to evaluate patients’ frailty.”

In their evaluation of this scoring system, Palumbo and colleagues conducted a pooled analysis of 869 patients newly diagnosed with multiple myeloma taken from three clinical trials. Each trial assessed patients for comorbidities, cognitive, and physical status. Using this information plus the patient’s age, the researchers developed a scoring system ranging from 0 to 5 to classify patients as fit (score of 0; 39%), intermediate fitness (score of 1; 31%), or as frail (score greater than 2; 30%).

With a median follow-up of 18 months, the 3-year overall survival was 84% in fit patients compared with 76% in intermediate fitness patients (HR = 1.61, 95% CI; 1.02-2.56, P = .042) and 57% in frail patients (HR = 3.57, 95% CI; 2.37-5.39, P < .001). The researchers found that even after adjustment for staging and treatment the frailty profiles were still associated with overall survival.

Patients of intermediate fitness also had a slightly increased risk for grade 3 or higher non-hematologic adverse events (HR = 1.13; 95% CI, 0.81-1.58), and those classified as frail had a significantly increased risk (HR = 1.57; 95% CI, 1.12-2.19). Grade 3 or higher non-hematologic adverse events were reported in 18% of fit patients, 22% of intermediate fitness patients, and 30% of frail patients.

Finally, 17% of patients classified as fit had drug discontinuation for any cause, excluding death and progression; whereas 22% of intermediate fitness and 25% of frail patients had drug discontinuation. Overall both intermediate fitness and frail patients had a significantly increased risk of drug discontinuation compared with fit patients. 

“By combining the frailty score with the established International Staging System (ISS), the 3-year overall survival rate was 55% in the frail-ISS 3 group, and 94% in the fit-ISS 1 group,” the researchers wrote. “The combination of these two independent parameters significantly improved the prognostic value of the single ones, therefore this is an important strategy in the future for predicting outcome.”

According to the researchers, this scoring system “could be used in everyday clinical practice as well as in the context of research to ensure an adequate representation of elderly patients and to allow more precise cross-trial comparisons.”