Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada.
Hematology Am Soc Hematol Educ Program. 2021 Dec 10;2021(1):46-54. doi: 10.1182/hematology.2021000231.
Older adults with multiple myeloma (MM) are a growing population, and personalizing treatment based on disease and health status is imperative. Similar to MM staging systems that provide disease-related prognostic information, myeloma-specific frailty tools can better identify subgroups at greatest risk for treatment-related toxicity and early treatment discontinuation, as well as predict overall survival. Several myeloma-specific validated tools are well studied. Although these fitness/frailty scores have shaped our understanding of the heterogeneity among older adults with myeloma, the application of such scores in treatment decision making (ie, transplant considerations, relapse) is an unmet need. Here we outline how to incorporate frailty assessments in the evaluation of older adults with MM in the clinical setting with consideration of other factors such as patient preferences, treatment risks/benefits, life expectancy, and disease biology.
患有多发性骨髓瘤 (MM) 的老年人是一个不断增长的群体，根据疾病和健康状况为他们制定个性化的治疗方案至关重要。类似于提供与疾病相关预后信息的 MM 分期系统，骨髓瘤特异性虚弱工具可以更好地识别治疗相关毒性和早期治疗中断风险最大的亚组，以及预测总生存期。已经对几种骨髓瘤特异性验证工具进行了深入研究。尽管这些体能/虚弱评分改变了我们对骨髓瘤老年患者异质性的认识，但这些评分在治疗决策中的应用（例如，移植考虑、复发）仍然是一个未满足的需求。在这里，我们概述了如何在临床环境中评估多发性骨髓瘤老年患者时纳入虚弱评估，并考虑患者的偏好、治疗风险/获益、预期寿命和疾病生物学等其他因素。
