Chan Henry, Chong Yih Harng, Seow Min Yee, Li Jian, Garg Priya, Kelly Meaghan, Neylon Annette, McDiarmid Bridgett, Tan Sarah, Jackson Sharon
Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
MidCentral District Health Board, Palmerston North, New Zealand.
J Geriatr Oncol. 2021 May;12(4):515-520. doi: 10.1016/j.jgo.2020.09.031. Epub 2020 Oct 10.
Frailty is a known risk factor for older patients with myeloma. Here we present realworld data using a computer-generated frailty assessment score (FRAIL score), based on 5 clinically derived parameters, in predicting patient outcomes.
Older patients with newly diagnosed multiple myeloma who received frontline treatment with cyclophosphamide-bortezomib-dexamethasone had their FRAIL score retrospectively assessed. Treatment outcomes were assessed using standard IMWG criteria, and event free survival and overall survival determined.
155 patients were analysed. Compared to those who were assessed as non-frail (FRAIL score 0-1) likely-frail patients (score ≥ 2) were less likely to complete the full course of treatment (24.3% vs 53.4%, p = 0.002), and more likely to terminate treatment due to toxicities (35.1% vs 22.0%, p = 0.109), as well as having a greater number of patients stop treatment early for reasons other than toxicity or progression (27.0% vs 10.2%, p = 0.010). After a median follow up of 42.5 months, likely-frail patients were found to have a trend for shorter event-free survival (median EFS, 8.7 vs 17.9 months, p = 0.064) and statistically inferior overall survival (median OS, 30.2 vs 49.8 months, p < 0.001). After adjusting for age, stage, and Charlson comorbidity index, FRAIL score was prognostic for OS (HR = 3.47, 95% CI 1.88-6.4), but not EFS (HR = 1.28, 95%CI 0.79-2.06).
The FRAIL score is independently predictive of overall survival in older patients with myeloma receiving bortezomib-based induction chemotherapy and can help identify those patients more likely to experience treatment toxicity.
衰弱是老年骨髓瘤患者的一个已知风险因素。在此，我们展示了基于5个临床衍生参数的计算机生成的衰弱评估分数（FRAIL分数）的真实世界数据，用于预测患者的预后。
对接受环磷酰胺 - 硼替佐米 - 地塞米松一线治疗的新诊断多发性骨髓瘤老年患者进行FRAIL分数的回顾性评估。使用标准的国际骨髓瘤工作组（IMWG）标准评估治疗结果，并确定无事件生存期和总生存期。
分析了155例患者。与被评估为非衰弱（FRAIL分数0 - 1）的患者相比，可能衰弱的患者（分数≥2）完成整个疗程的可能性较小（24.3%对53.4%，p = 0.002），因毒性终止治疗的可能性更大（35.1%对22.0%，p = 0.109），并且有更多患者因毒性或疾病进展以外的原因提前停止治疗（27.0%对10.2%，p = 0.010）。中位随访42.5个月后，发现可能衰弱的患者无事件生存期有缩短趋势（中位无事件生存期，8.7对17.9个月，p = 0.064），总生存期在统计学上较差（中位总生存期，30.2对49.8个月，p < 0.001）。在调整年龄、分期和Charlson合并症指数后，FRAIL分数对总生存期具有预后价值（风险比[HR]=3.47，95%置信区间[CI] 1.88 - 6.4），但对无事件生存期无预后价值（HR = 1.28，95%CI 0.79 - 2.06）。
FRAIL分数可独立预测接受基于硼替佐米诱导化疗的老年骨髓瘤患者的总生存期，并有助于识别那些更可能经历治疗毒性的患者。
