title: Assessment of vulnerability measures and their effect on survival in a real-life population of multiple myeloma patients registered at Marche Region Multiple Myeloma Registry.
abstract: Multiple myeloma (MM) therapy should be tailored according to patient characteristics although we do not know which ones to use. By studying the characteristics of 266 real-life patients, we found performance status (PS) and Charlson Comorbidity Index (CCI) as factors affecting survival of MM patients regardless of their disease characteristics. This study might help to select patients for tailoring therapy in clinical practice.
  
  
  BACKGROUND
  Multiple myeloma is a typical disease of the elderly but how many and which patients can be considered 'vulnerable' and how this may affect patient outcome remain unsolved issues.
  
  
  METHODS
  Data from 266 symptomatic MM patients registered at Marche MM registry from 2007 to 2010 were evaluated retrospectively. Vulnerability was defined as age > 75 years, PS (World Health Organization) ≥ 2, renal insufficiency (RI), bone fracture, cytopenias, and CCI score ≥ 1. Kaplan-Meier method and Cox regression were used to assess survival and associated factors. A vulnerability score (VS) incorporating significant vulnerability features was pursued to predict survival.
  
  
  RESULTS
  Thirty-eight percent of patients were older than 75 years, 39% had PS = 2-4, 35% had at least 2 cytopenias, 40% had bone fracture, 14% RI, and 51% had CCI score ≥ 1. Cox regression selected international staging system (ISS) = III (hazard ratio [HR] = 1.6; P = .033), PS = 2-4 (HR = 2.5; P = .007), and CCI = 1-3 (HR = 2.1; P = .028) as factors associated with a worse overall survival. A VS including PS and CCI predicted median survival of 27 months in the 63 patients having a VS = 2 (both PS = 2-4 and CCI = 1-3) versus not reached (NR) in the 203 patients with VS = 0-1 (HR = 4.0; P < .0001). In younger patients multivariate analysis selected ISS = III (HR = 5.2; P = .006) and VS = 2 (HR = 5.5; P = .024) as factors associated with shorter survival whereas only VS = 2 (HR = 3.5; P = .002) affected worse survival in elderly.
  
  
  CONCLUSIONS
  Such VS proved to be a powerful prognostic factor for survival of MM patients and it might be useful to identify true vulnerable patients regardless of age.
authors.affiliation: Clinica di Ematologia Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy. m.offidani@ospedaliriuniti.marche.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Laura
authors.initials: L
authors.lastname: Corvatta
authors.forename: Claudia
authors.initials: C
authors.lastname: Polloni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Centurioni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visani
authors.forename: Marino
authors.initials: M
authors.lastname: Brunori
authors.forename: Silvia
authors.initials: S
authors.lastname: Gentili
authors.forename: Massimo
authors.initials: M
authors.lastname: Catarini
authors.forename: Arduino
authors.initials: A
authors.lastname: Samori
authors.forename: Nicola
authors.initials: N
authors.lastname: Blasi
authors.forename: Francesco
authors.initials: F
authors.lastname: Alesiani
authors.forename: Patrizia
authors.initials: P
authors.lastname: Caraffa
authors.forename: Maurizio
authors.initials: M
authors.lastname: Burattini
authors.forename: Piero
authors.initials: P
authors.lastname: Galieni
authors.forename: Paolo
authors.initials: P
authors.lastname: Fraticelli
authors.forename: Mario
authors.initials: M
authors.lastname: Ferranti
authors.forename: Luciano
authors.initials: L
authors.lastname: Giuliodori
authors.forename: Pietro
authors.initials: P
authors.lastname: Leoni
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome