Geriatric assessment in hematology scale predicts treatment tolerability in older patients diagnosed with hematological malignancies: The RETROGAH study

Rubia, Javier de la; González, Bernardo; Cruz-Jentoft, A.J.; Iglesias, Lorena; Jarque, Isidro; Persona, Ernesto Pérez; Lluch, Rafael; Marrero, Carmen; Zudaire, Maite; Gironella, Mercedes; Hernández‐Rivas, José Ángel; Arnán, Montserrat; Olivier, C; Encinas, Cristina; Soler, Juan Alfonso; Payer, Ángel Ramírez; Casado, Alfonso; Fernández, Patricia; Vilanova, David; Bonanad, Santiago

doi:10.1016/j.jgo.2022.10.016

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…9 This integration allows all users to readily distinguish t from frail patients and expeditiously adjust therapy intensity during our weekly performed interdisciplinary MM-TB discussion. 9,10,13,14 While various functional tests, including different comorbidity scores and geriatric functional tests have been examined, 13,[27][28][29][30] the R-MCI was explicitly helpful to individualize treatment decisions and improving the tolerance of MM therapy. 10 Additionally, the R-MCI has been recognized as the only comorbidity index that did not show signi cant differences in risk group distribution for both retrospective and prospective data, thus it was reliably assessable from both data sets.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, FA is superior in specifying patients' constitution and biological age [7][8][9][10][11][12][13][14]24 which is why treatment decisions should rather depend on FA tools, such as R-MCI or others. 12,23,24,[27][28][29][30] Strengths of our analysis included the precise examination of a large MM-TB cohort, the repeated R-MCI analysis, and the observed dose reduction, well-associated with R-MCI-, rather than age-subgroups. Our observation period of 3 years was substantial, and the detailed examination of patients with various numbers of TB presentations and deterioration in their health status (R-MCI) exhibited their complexity.…”

Section: Discussionmentioning

confidence: 99%

“…The aim of this study was therefore not to determine exact therapy choices of newly diagnosed MM vs. relapsed/refractory MM, or within different therapy lines, nor whether patients did pro t from dose-reductions, because we and others had shown this in prior publications. 7,8,10,[27][28][29][30][37][38][39][40][41][42][43][44] Moreover, our follow-up assessment was conducted within a relatively short period which should ideally be performed after ~ 1 year, according to Scheubeck and Holler. 10,13 Another criticism may arise from the retrospective evaluation of three patients (whose R-MCI was unavailable in TOS and who received different, more intensive treatment due to the unavailability of their R-MCI).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Original Paper Optimizing individualized therapy decision-making in multiple myeloma (MM): Integration and impact of the Revised Myeloma Comorbidity Index in the MM-Tumor Board

Dreyling,

Ihorst,

Reinhardt

et al. 2024

Preprint

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Introduction: Multiple Myeloma (MM) is a hematological disease predominantly affecting elderly patients. The complexity of current treatment necessitates individualized approaches. Therein, functional assessment (FA) tools, such as the Revised Comorbidity Index (R-MCI) at our University- and Comprehensive Cancer Center Freiburg, play a crucial role. This study aimed to determine a) the implementation of the R-MCI in our MM-tumor board (MM-TB), b) its impact on treatment guidance at baseline and c) potential changes during follow-up. Methods: This exploratory study investigated R-MCI coverage and distribution in a cohort of patients with multiple TB presentations. Among them, a follow-up patient cohort undergoing subsequent MM-therapy was analyzed to determine treatment adjustments and changes in patients’ condition measured by R-MCI alterations. Results: During our 3-year assessment period, 565 patients were presented in our MM-TB, totaling 1256 TB-presentations. In the multiple TB presentation cohort, the median number of TB presentations was 3 (range: 2–12). R-MCI scores within the MM-TB were available in 94%, whereas in 6%, the R-MCI had not been integrated. Among these, potential failure to identify the need for treatment modifications was determined. In the follow-up cohort, patient characteristics were typical for referral/university centers. Dose reductions were performed in 55% and were more prevalent among patients with ≥ 4 vs. lesser TB presentations. Most patients (55%) showed a fitness stabilization or improvement via follow-up R-MCI. Conclusion: R-MCI integration in MM-TB exceeded > 90%, indicating its successful integration for treatment support. Our results underscore its value in guiding therapy decisions, providing a comprehensive assessment beyond age considerations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Original Paper Optimizing individualized therapy decision-making in multiple myeloma (MM): Integration and impact of the Revised Myeloma Comorbidity Index in the MM-Tumor Board

Dreyling,

Ihorst,

Reinhardt

et al. 2024

Preprint

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“…The GHA scale was specifically designed for the evaluation of older subjects with different hematological malignancies, 33% of whom were affected by CLL. Interestingly, the mean time to complete the scale was only 12 min [39], and the GAH scale was validated by additional studies [40].…”

Section: Impact Of Cgamentioning

confidence: 99%

First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era

Urso,

Cavazzini,

Ballardini

et al. 2023

Cancers

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Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability.

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“…Clinicians evaluate a patient's eligibility for chemotherapy based on factors like general health, comorbidities, and specific assessments for older patients. The specific assessment criteria have been summarized in Table 3 42–49 …”

Section: Mfc‐mrd Monitoring Of Therapeutic Efficacy In Different Ther...mentioning

confidence: 99%

Minimal residual disease monitoring in acute myeloid leukemia: Focus on MFC‐MRD and treatment guidance for elderly patients

Sun,

Zhu,

Zhong

2024

European J of Haematology

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Acute myeloid leukemia (AML) is distinguished by clonal growth of myeloid precursor cells, which impairs normal hematopoiesis. Minimal residual disease (MRD) refers to the residual leukemia cells that persist after chemotherapy. Patients who test positive for MRD have a higher likelihood of experiencing a recurrence, regardless of the specific chemotherapy approach used. Multi‐parameter flow cytometry (MFC), polymerase chain reaction (PCR), and next‐generation sequencing (NGS) are commonly employed techniques for identifying MRD. In the context of AML, patients are frequently monitored for measurable residual disease via multi‐parameter flow cytometry (MFC‐MRD). In order to explore recent advancements in AML and MRD diagnosis, an extensive search of the PubMed database was conducted, focusing on relevant research in the past 20 years. This review aims to examine various MRD monitoring methods, the optimal time points for assessment, as well as different specimen types used. Additionally, it underscores the significance of MFC‐MRD assessment in guiding the treatment of elderly AML.

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Geriatric assessment in hematology scale predicts treatment tolerability in older patients diagnosed with hematological malignancies: The RETROGAH study

Cited by 12 publications

References 22 publications

Original Paper Optimizing individualized therapy decision-making in multiple myeloma (MM): Integration and impact of the Revised Myeloma Comorbidity Index in the MM-Tumor Board

Original Paper Optimizing individualized therapy decision-making in multiple myeloma (MM): Integration and impact of the Revised Myeloma Comorbidity Index in the MM-Tumor Board

First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era

Minimal residual disease monitoring in acute myeloid leukemia: Focus on MFC‐MRD and treatment guidance for elderly patients

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