Summary
Integrating geriatric assessments may lead to individual treatment decisions, dose adjustments, better clinical outcome and QoL. Prospective clinical trials that enroll elderly multiple myeloma patients with comorbidities, incorporate frailty scores/geriatric assessments and help with prognostication, adverse event avoidance and QoL maintenance, remain warranted.
Original Article
Geriatric assessments and frailty scores in multiple myeloma patients: a needed tool for individualized treatment?
Current Opinion in Oncology
Möller, Mandy-Deborah; Gengenbach, Laura; Graziani, Giulia; Greil, Christine; Wäsch, Ralph; Engelhardt, Monika
Abstract
Purpose of review
Multiple myeloma is a disease of elderly adults. Improvement in survival has occurred because of biological insights and novel agents. Therapeutic options involve choices today, thus have become more complex. Demographics have led to an increased number of elderly patients and age may be associated with a poorer outcome but is not the only prognostic predictor today.
Recent findings
To evaluate patients’ health status rather than their chronological age alone, frailty scores and functional geriatric assessments are used to identify prognostic groups, avoid adverse events, compare clinical trials and tailor treatment. As most clinical trials exclude frail elderly patients, those enrolled therein are often younger and healthier than the typical multiple myeloma patient. This represents a challenge for frail cohorts because of their increased risk of adverse events, overtreatment and undertreatment and/or therapy discontinuation, which may lead to poorer survival and quality of life (QoL). Reassessing patients’ status via geriatric assessments is also relevant during treatment to adjust interventions appropriately.
Summary
Integrating geriatric assessments may lead to individual treatment decisions, dose adjustments, better clinical outcome and QoL. Prospective clinical trials that enroll elderly multiple myeloma patients with comorbidities, incorporate frailty scores/geriatric assessments and help with prognostication, adverse event avoidance and QoL maintenance, remain warranted.
Acknowledgements
The authors thank distinguished IMWG, EMN, DSMM and GMMG myeloma experts for their advice, recommendations and insightful, inspiring comments. M.E. and all authors also thank all German, Austrian, Swiss, European and international elderly task forces for their support, and especially Professor Dr Justus Duyster (Freiburg, UKF) and the CCCF. We are also very thankful to all AG Engelhardt & Wäsch group members, especially Drs Heike Reinhardt, Amelie Rösner, Magdalena Braun and Stefanie Adebola Ajayi for their chemotherapy surveillance work, including their MM enthusiasm. We also thank the members of our MM-tumorboard group, MM self-help group Freiburg and Center for biobanking (FREEZE-Biobank) for their support. We are very grateful for the advice of numerous MM experts, that is, from Gordon Cook, Alessandra Larocca, Valentin Goede, Ulrich Wedding, Holger Auner, Kwee Yong, Shaji Kumar, Annamaria Brioli and Sonja Zweegman, who we discussed earlier thoughts, projects and future trial ideas with. This work was supported by the DKH.