Chen Yadong, Gu Jingli, Huang Beihui, Liu Junru, Li Xiaozhe, Li Juan
Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2023 Jan 20;13:1103687. doi: 10.3389/fonc.2023.1103687. eCollection 2023.
The physical fitness of older individuals is heterogeneous, making it difficult to know their chemotherapy tolerance. The toxicities may offset the benefits of anti-myeloma therapy in frail patients. The accurate evaluation of frailty status before chemotherapy is essential. We aimed to explore the applicability of the IMWG GA and develop a new frailty screening tool more suitable for Chinese MM patients.
We performed the IMWG GA and the full CGA in 167 MM patients and validated the applicability of the IMWG GA to chemotherapy and prognosis. The CGA domains were screened for their predictive value to improve IMWG GA and develop new frailty screening tools.
The results showed that the IMWG GA had limitations in distinguishing the risk of grade ≥3 adverse events (AEs) between fit and int-fit patients. Of the CGA domains, TUG and MNA-SF were independent prognostic factors for grade ≥3 AEs and OS and further stratified the risk of grade ≥3 AEs in the IMWG GA int-fit subgroup (P< 0.05). We combined TUG and MNA-SF to construct the TM frailty score. The frail subgroup had a higher proportion of adverse outcomes, a higher hazard ratio (HR) in Cox regression and a higher Harrell's C-index for distinguishing the risk of grade ≥3 AEs and OS than the IMWG GA frail subgroup.
The TM frailty score is more suitable than the IMWG GA for evaluating chemotherapy tolerance and prognosis in the Chinese population.
老年个体的体能存在异质性，难以了解他们对化疗的耐受性。毒性可能会抵消抗骨髓瘤治疗对体弱患者的益处。化疗前准确评估体弱状态至关重要。我们旨在探索国际骨髓瘤工作组（IMWG）体能评估（GA）的适用性，并开发一种更适合中国多发性骨髓瘤（MM）患者的新的体弱筛查工具。
我们对167例MM患者进行了IMWG GA和全面的综合老年评估（CGA），并验证了IMWG GA对化疗和预后的适用性。对CGA各领域进行预测价值筛查，以改进IMWG GA并开发新的体弱筛查工具。
结果显示，IMWG GA在区分健康和非健康患者发生≥3级不良事件（AE）的风险方面存在局限性。在CGA各领域中，定时起立行走测试（TUG）和微型营养评定法简表（MNA-SF）是≥3级AE和总生存期（OS）的独立预后因素，并进一步对IMWG GA非健康亚组中≥3级AE的风险进行了分层（P<0.05）。我们将TUG和MNA-SF相结合构建了TM体弱评分。与IMWG GA体弱亚组相比，体弱亚组不良结局的比例更高，Cox回归中的风险比（HR）更高，在区分≥3级AE和OS风险方面的Harrell's C指数更高。
对于评估中国人群的化疗耐受性和预后，TM体弱评分比IMWG GA更合适。
