title: Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report.
abstract: We conducted a pooled analysis of 869 individual newly diagnosed elderly patient data from 3 prospective trials. At diagnosis, a geriatric assessment had been performed. An additive scoring system (range 0-5), based on age, comorbidities, and cognitive and physical conditions, was developed to identify 3 groups: fit (score = 0, 39%), intermediate fitness (score = 1, 31%), and frail (score ≥2, 30%). The 3-year overall survival was 84% in fit, 76% in intermediate-fitness (hazard ratio [HR], 1.61; P = .042), and 57% in frail (HR, 3.57; P < .001) patients. The cumulative incidence of grade ≥3 nonhematologic adverse events at 12 months was 22.2% in fit, 26.4% in intermediate-fitness (HR, 1.23; P = .217), and 34.0% in frail (HR, 1.74; P < .001) patients. The cumulative incidence of treatment discontinuation at 12 months was 16.5% in fit, 20.8% in intermediate-fitness (HR, 1.41; P = .052), and 31.2% in frail (HR, 2.21; P < .001) patients. Our frailty score predicts mortality and the risk of toxicity in elderly myeloma patients. The International Myeloma Working group proposes this score for the measurement of frailty in designing future clinical trials. These trials are registered at www.clinicaltrials.gov as #NCT01093136 (EMN01), #NCT01190787 (26866138MMY2069), and #NCT01346787 (IST-CAR-506).
authors: Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;
authors: Antonio
authors: A
authors: Palumbo
authors: Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;
authors: Sara
authors: S
authors: Bringhen
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Centro de Investigación del Cáncer, Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca-Centro Superior de Investigaciones Científicas, Salamanca, Spain;
authors: Maria-Victoria
authors: MV
authors: Mateos
authors: Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;
authors: Alessandra
authors: A
authors: Larocca
authors: Department of Hematology, University Hospital, Lille, France;
authors: Thierry
authors: T
authors: Facon
authors: Division of Hematology, College of Medicine, Mayo Clinic, Rochester, MN;
authors: Shaji K
authors: SK
authors: Kumar
authors: Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy;
authors: Massimo
authors: M
authors: Offidani
authors: Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY;
authors: Philip
authors: P
authors: McCarthy
authors: Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;
authors: Andrea
authors: A
authors: Evangelista
authors: Department of Hematology and Medical Oncology, Emory University, Atlanta, GA;
authors: Sagar
authors: S
authors: Lonial
authors: Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands;
authors: Sonja
authors: S
authors: Zweegman
authors: Scientific Direction, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy;
authors: Pellegrino
authors: P
authors: Musto
authors: Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece;
authors: Evangelos
authors: E
authors: Terpos
authors: Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada;
authors: Andrew
authors: A
authors: Belch
authors: Department of Haematooncology and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic;
authors: Roman
authors: R
authors: Hajek
authors: Department of Oncology, Hematology and Palliative Care, Wilhelminen, Vienna, Austria;
authors: Heinz
authors: H
authors: Ludwig
authors: Division of Hematology-Oncology, Mayo Clinic, Scottsdale, AZ;
authors: A Keith
authors: AK
authors: Stewart
authors: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France;
authors: Philippe
authors: P
authors: Moreau
authors: Department of Hematology/Oncology, Dana-Farber Cancer Institute, Boston, MA;
authors: Kenneth
authors: K
authors: Anderson
authors: Medical Clinic and Polyclinic II, Department of Internal Medicine II, University Hospital, Wuerzburg, Germany;
authors: Hermann
authors: H
authors: Einsele
authors: Department of Hematology/Oncology, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA;
authors: Brian G M
authors: BG
authors: Durie
authors: Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece;
authors: Meletios A
authors: MA
authors: Dimopoulos
authors: Multiple Myeloma section, National Cancer Institute, Bethesda, MD;
authors: Ola
authors: O
authors: Landgren
authors: Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, Pamplona, Spain;
authors: Jesus F
authors: JF
authors: San Miguel
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and.
authors: Paul
authors: P
authors: Richardson
authors: Department of Hematology, Erasmus Medical Center and HOVON Data Center, Rotterdam, The Netherlands.
authors: Pieter
authors: P
authors: Sonneveld
authors: Division of Hematology, College of Medicine, Mayo Clinic, Rochester, MN;
authors: S Vincent
authors: SV
authors: Rajkumar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality*; D011379:Prognosis; D028761:Withholding Treatment / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents
references: Haematologica. 2013 Jun;98(6):980-7
references: 23445873
references: Lancet. 2013 Mar 2;381(9868):752-62
references: 23395245
references: J Clin Oncol. 2013 Feb 1;31(4):448-55
references: 23233713
references: Haematologica. 2013 Jan;98(1):87-94
references: 22875621
references: J Clin Oncol. 2014 Feb 20;32(6):587-600
references: 24419113
references: Blood. 2014 Jul 3;124(1):63-9
references: 24855212
references: N Engl J Med. 2014 Sep 4;371(10):906-17
references: 25184863
references: Leukemia. 2014 Feb;28(2):269-77
references: 23974982
references: N Engl J Med. 1999 Dec 30;341(27):2061-7
references: 10615079
references: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
references: 11253156
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Psychopharmacol Bull. 1988;24(4):609-14
references: 3074322
references: Blood. 1999 Jan 1;93(1):51-4
references: 9864145
references: Stat Med. 1999 Mar 30;18(6):695-706
references: 10204198
references: J Clin Oncol. 2005 May 20;23(15):3412-20
references: 15809451
references: Crit Rev Oncol Hematol. 2005 Sep;55(3):241-52
references: 16084735
references: Br J Haematol. 2006 May;133(4):389-96
references: 16643445
references: Med Clin North Am. 2006 Jul;90(4):593-601
references: 16843764
references: Blood. 2008 Mar 1;111(5):2516-20
references: 17975015
references: N Engl J Med. 2008 Aug 28;359(9):906-17
references: 18753647
references: Eur J Cancer. 2010 Jan;46(1):160-9
references: 19682891
references: Blood. 2010 Aug 5;116(5):679-86
references: 20385792
references: N Engl J Med. 2011 Mar 17;364(11):1046-60
references: 21410373
references: Cochrane Database Syst Rev. 2011;(7):CD006211
references: 21735403
references: Ann Oncol. 2011 Aug;22(8):1922-6
references: 21266517
references: Blood. 2011 Aug 4;118(5):1239-47
references: 21670471
references: J Natl Compr Canc Netw. 2012 Feb;10(2):162-209
references: 22308515
references: N Engl J Med. 2012 May 10;366(19):1759-69
references: 22571200
references: Lancet Oncol. 2012 Oct;13(10):e437-44
references: 23026829
references: N Engl J Med. 2012 Nov 22;367(21):1972-4
references: 23171092