Comprehensive geriatric assessment in newly diagnosed older myeloma patients: a multicentre, prospective, non-interventional study

Abstract

Background Multiple myeloma is a disease of the older people, whose prognoses are highly heterogeneous. The International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based on age, functional status and comorbidities to discriminate between fit and frail patients. Given the multidimensional nature of frailty and the relatively recent exploration of frailty in the field of MM, reaching a consensus on the measurement of frailty in MM patients remains challenging. Objective We sought to assess the feasibility of performing a comprehensive GA (CGA) in older MM patients in a real-world and multicentre setting and to evaluate their baseline CGA profiles. Results We studied 349 older patients with newly diagnosed MM (age range, 65–86 years). Our results showed that a CGA is feasible for older MM patients. Using the IMWG-GA criteria, we identified significantly more frail patients in our cohort comparing to in the IMWG cohort (43% vs 30%, P = 0.002). In the IMWG-GA ‘fit’ group, risk of malnutrition, depression and cognitive impairment remains. The median follow-up time was 26 months (range 1–38). The median overall survival (OS) was 34.7 months, and the estimated 3-year OS rate was 50%. A high MNA-SF score (MNA-SF ≥ 12), low GDS score (GDS ≤ 5) and high CCI score (CCI ≥ 2) can be used to predict the OS of older patients with newly diagnosed MM. This study is registered at www.clinicaltrials.gov (NCT03122327). Conclusions Our study justifies the need for a CGA in older patients with newly diagnosed MM.

Front‐line treatment efficacy and clinical outcomes of elderly patients with multiple myeloma in a real‐world setting: A multicenter retrospective study in China

“… 10 The European Myeloma Network proposed that elderly MM patients should adopt different treatment intensities according to their fitness, 19 but currently the GA score is not widely used in the real world. The proportion of frail patients in our study was 35.78% (73/204) which was close to the report by Li et al 20 Our data suggested that GA score indicating fitness was independently correlated with longer OS, which was consistent with the conclusions in clinical trial. 10 In a retrospective study all the patients were treated with bortezomib‐based regimen and the frail patients had shorter OS compared with fit and moderate‐fit patients (49 months vs. 63 months vs.63 months, p < 0.05).…”

Comorbidity characteristics of multiple myeloma patients diagnosed in Finland 2005–2016

“…From a practical perspective, a sufficient level of geriatric assessment (GA) of elderly MM patients at diagnosis is also critical to account for all relevant comorbidities that may guide treatment. A recent multicenter prospective study suggests that a comprehensive GA (CGA) is warranted in newly diagnosed elderly MM patients and may provide some added benefit to assessing patient frailty compared to the International Myeloma Working Group (IMWG) recommendations [ 32 ]. In Finland, a survey study concluded that the majority of geriatricians utilized the CGA in their general practice, but only 11% of respondents incorporated all five domains in their CGA [ 33 ].…”

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study

“…Mini Nutritional Assessment-Short Form (MNA-SF) is a standard method to evaluate the nutritional status of the elderly. The Chinese version of MNA-SF performed well, and a score of 12–14 points is normal nutritional status, 8–11 points are at risk of malnutrition, and 0–7 points indicate malnutrition ( Amasene et al, 2021 ; Yao et al, 2022 ). Furthermore, intraoperative data (operation time, anesthetic time, and general anesthesia method) (intravenous, inhalation, or a combination of both ways) were accessed from medical records.…”