Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
Center for Myeloma, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
J Geriatr Oncol. 2019 May;10(3):486-489. doi: 10.1016/j.jgo.2018.10.010. Epub 2018 Nov 22.
We compared the performance of two frailty scoring systems in predicting survival among older patients with multiple myeloma: the International Myeloma Working Group (IMWG) frailty score (which includes age), and the Fried model for frailty (which does not).
From 2015 to 2018, all patients aged 75 years and older presenting at our institution with a diagnosis of multiple myeloma were approached for a frailty screening assessment. We first categorized patients' frailty using the Fried model. Then, using available deficit measures, we reclassified frailty using the IMWG approach. We compared the performance of the IMWG strategy to the Fried model in terms of association with overall survival.
Of the 98 (92%) patients who consented to a baseline frailty assessment, we found 57% discordance among frailty classification between the two scoring systems. Using the IMWG strategy, 9% of the cohort was "fit," 29% "intermediate-fit," and 62% "frail." Using the Fried model, 29% of the cohort was "robust," 52% "pre-frail," and 19% "frail." Frailty category in the Fried model was predictive of overall survival among our cohort, while frailty category in the IMWG strategy was not (log-rank p = 0.04 vs. 0.34).
Among our cohort of older patients with myeloma (aged 75 and higher), the Fried model appears to be a better predictor of survival compared to the IMWG strategy. These results suggest that using age as a criterion to identify frailty in older patients with multiple myeloma may limit treatment options for the functionally vigorous.
我们比较了两种虚弱评分系统在预测多发性骨髓瘤老年患者生存中的表现：国际骨髓瘤工作组（IMWG）虚弱评分（包括年龄）和弗里德虚弱模型（不包括年龄）。
2015 年至 2018 年，我们机构对所有 75 岁及以上诊断为多发性骨髓瘤的患者进行了虚弱筛查评估。我们首先使用弗里德模型对患者的虚弱状况进行分类。然后，使用可用的缺陷指标，我们使用 IMWG 方法重新分类虚弱状况。我们比较了 IMWG 策略与弗里德模型在与总体生存的关联方面的表现。
在 98 名（92%）同意进行基线虚弱评估的患者中，我们发现两种评分系统之间的虚弱分类存在 57%的不一致。使用 IMWG 策略，队列中有 9%的患者为“健康”，29%为“中等健康”，62%为“虚弱”。使用弗里德模型，队列中有 29%的患者为“健壮”，52%为“衰弱前期”，19%为“虚弱”。在我们的队列中，弗里德模型的虚弱类别预测总体生存，而 IMWG 策略的虚弱类别则不然（对数秩检验 p=0.04 与 0.34）。
在我们的骨髓瘤老年患者队列中（年龄在 75 岁及以上），与 IMWG 策略相比，弗里德模型似乎是一个更好的生存预测指标。这些结果表明，在多发性骨髓瘤老年患者中使用年龄作为确定虚弱的标准可能会限制功能活跃患者的治疗选择。
