title: Prognostic effect of comorbidity indices in elderly patients with multiple myeloma.
abstract: BACKGROUND
  Consideration of comorbidity, disability, and frailty represents a significant part of the treatment of elderly multiple myeloma (MM) patients. The aim of study was to analyze the effect of the Charlson Comorbidity Index (CCI) and scale of Instrumental Activities of Daily Living (IADL) on the course of disease.
  
  
  METHODS
  The study included 110 newly diagnosed MM patients older than 65 years of age. According to the CCI most patients had at least 1 comorbidity (CCI score of 1) and most of them (51 of 110 patients; 46.4%) had an age-adjusted CCI (aaCCI) score of 5 to 6. Most of our patients were capable of performing routine daily activities (IADL ≥ 6). Patients were treated with thalidomide- and bortezomib- based combinations, or with conventional chemotherapy.
  
  
  RESULTS
  International Staging System (ISS) score 3 correlated with high scores of CCI or aaCCI (R = 0.314, P < .003; R = .317, P < .002, respectively), and lower IADL (R = 0.259, P < .007). The probability of adverse events was 70% greater for CCI score ≥ 2 (odds ratio [OR], 1.72); 28% for aaCCI ≥ 5 (OR, 1.28) and 22% higher for IADL < 3 (OR, 2.25). The patients with a CCI score of 0 to 1 had significantly longer overall survival (OS; log rank, 6.538; P < .011). The patients with aaCCI ≥ 5 had significantly shorter OS (log rank, 4.209; P < .040), and the patients with IADL > 3 had significantly longer OS (log rank, 6.62; P < .001). In the proposed model, aaCCI ≥ 5 and IADL > 3 scores had a major effect on the OS (χ(2), 8.46; P = .037).
  
  
  CONCLUSIONS
  CCI, aaCCI, and IADL scale are clinical parameters of prognostic significance. A proposed model for a personalized treatment approach is based on variables such as scores for aaCCI ≥ 5 and IADL > 3.
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: jbila@yubc.net.
authors: Jelena
authors: J
authors: Bila
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Jelena
authors: J
authors: Jelicic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.
authors: Vladislava
authors: V
authors: Djurasinovic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Vojin
authors: V
authors: Vukovic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.
authors: Aleksandra
authors: A
authors: Sretenovic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.
authors: Bosko
authors: B
authors: Andjelic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Darko
authors: D
authors: Antic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Milena
authors: M
authors: Todorovic
authors: Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Biljana
authors: B
authors: Mihaljevic
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis
keywords: Comorbidity Indices; Elderly patients; Multiple myeloma; Prognosis; Treatment