Henry Chan1, Yih Harng Chong2, Min Yee Seow3, Jian Li4, Priya Garg5, Meaghan Kelly6, Annette Neylon7, Bridgett McDiarmid7, Sarah Tan4, Sharon Jackson5. 1. Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. Electronic address: Henry.chan@waitematadhb.govt.nz. 2. MidCentral District Health Board, Palmerston North, New Zealand. 3. Older Adult and Home Health, Waitemata District Health Board, Auckland, New Zealand. 4. Department of Haematology, Waitemata District Health Board, Auckland, New Zealand. 5. Department of Haematology, Counties Manukau District Health Board, Auckland, New Zealand. 6. Department of Medicine, Southern District Health Board, Dunedin, New Zealand. 7. Department of Haematology, Southern District Health Board, Dunedin, New Zealand.
Abstract
INTRODUCTION: Frailty is a known risk factor for older patients with myeloma. Here we present realworld data using a computer-generated frailty assessment score (FRAIL score), based on 5 clinically derived parameters, in predicting patient outcomes. METHODS: Older patients with newly diagnosed multiple myeloma who received frontline treatment with cyclophosphamide-bortezomib-dexamethasone had their FRAIL score retrospectively assessed. Treatment outcomes were assessed using standard IMWG criteria, and event free survival and overall survival determined. RESULTS: 155 patients were analysed. Compared to those who were assessed as non-frail (FRAIL score 0-1) likely-frail patients (score ≥ 2) were less likely to complete the full course of treatment (24.3% vs 53.4%, p = 0.002), and more likely to terminate treatment due to toxicities (35.1% vs 22.0%, p = 0.109), as well as having a greater number of patients stop treatment early for reasons other than toxicity or progression (27.0% vs 10.2%, p = 0.010). After a median follow up of 42.5 months, likely-frail patients were found to have a trend for shorter event-free survival (median EFS, 8.7 vs 17.9 months, p = 0.064) and statistically inferior overall survival (median OS, 30.2 vs 49.8 months, p < 0.001). After adjusting for age, stage, and Charlson comorbidity index, FRAIL score was prognostic for OS (HR = 3.47, 95% CI 1.88-6.4), but not EFS (HR = 1.28, 95%CI 0.79-2.06). CONCLUSION: The FRAIL score is independently predictive of overall survival in older patients with myeloma receiving bortezomib-based induction chemotherapy and can help identify those patients more likely to experience treatment toxicity.
INTRODUCTION: Frailty is a known risk factor for older patients with myeloma. Here we present realworld data using a computer-generated frailty assessment score (FRAIL score), based on 5 clinically derived parameters, in predicting patient outcomes. METHODS: Older patients with newly diagnosed multiple myeloma who received frontline treatment with cyclophosphamide-bortezomib-dexamethasone had their FRAIL score retrospectively assessed. Treatment outcomes were assessed using standard IMWG criteria, and event free survival and overall survival determined. RESULTS: 155 patients were analysed. Compared to those who were assessed as non-frail (FRAIL score 0-1) likely-frail patients (score ≥ 2) were less likely to complete the full course of treatment (24.3% vs 53.4%, p = 0.002), and more likely to terminate treatment due to toxicities (35.1% vs 22.0%, p = 0.109), as well as having a greater number of patients stop treatment early for reasons other than toxicity or progression (27.0% vs 10.2%, p = 0.010). After a median follow up of 42.5 months, likely-frail patients were found to have a trend for shorter event-free survival (median EFS, 8.7 vs 17.9 months, p = 0.064) and statistically inferior overall survival (median OS, 30.2 vs 49.8 months, p < 0.001). After adjusting for age, stage, and Charlson comorbidity index, FRAIL score was prognostic for OS (HR = 3.47, 95% CI 1.88-6.4), but not EFS (HR = 1.28, 95%CI 0.79-2.06). CONCLUSION: The FRAIL score is independently predictive of overall survival in older patients with myeloma receiving bortezomib-based induction chemotherapy and can help identify those patients more likely to experience treatment toxicity.