Department of Oncology, McMaster University, Hamilton, Canada.
Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
Blood Cancer J. 2023 May 10;13(1):76. doi: 10.1038/s41408-023-00843-5.
Multiple myeloma (MM) is a cancer of older adults and those who are more frail are at high risk of poor outcomes. Current tools for identifying and categorizing frail patients are often static and measured only at the time of diagnosis. The concept of dynamic frailty (i.e. frailty changing over time) is largely unexplored in MM. In our study, adults with newly-diagnosed MM who received novel drugs between the years 2007-2014 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Using a previously published cumulative deficit approach, a frailty index score was calculated at diagnosis and each landmark interval (1-yr, 2-yr, 3-yr post diagnosis). The association of frailty with overall survival (OS) both at baseline and at each landmark interval as well as factors associated with worsening frailty status over time were evaluated. Overall, 4617 patients were included. At baseline, 39% of the patients were categorized as moderately frail or severely frail. Among those who had 3 years of follow-up, frailty categorization changed post diagnosis in 93% of the cohort (78% improved and 72% deteriorated at least at one time point during the follow up period). In a landmark analysis, the predictive ability of frailty at the time of diagnosis decreased over time for OS (Harrell's C Statistic 0.65 at diagnosis, 0.63 at 1-yr, 0.62 at 2-yr, and 0.60 at 3-yr) and was inferior compared to current frailty status at each landmark interval. Our study is one of the first to demonstrate the dynamic nature of frailty among older adults with MM. Frailty may improve or deteriorate over time. Current frailty status is a better predictor of outcomes than frailty status at time of diagnosis, indicating the need for re-measurement in this high-risk patient population.
多发性骨髓瘤（MM）是一种老年人疾病，身体虚弱的人预后不良的风险较高。目前用于识别和分类虚弱患者的工具往往是静态的，仅在诊断时进行测量。动态虚弱（即虚弱随时间变化）的概念在 MM 中尚未得到广泛探索。在我们的研究中，在 2007-2014 年间接受新型药物治疗的新诊断 MM 成年患者在监测、流行病学和最终结果（SEER）-医疗保险相关数据库中被确定。使用之前发表的累积缺陷方法，在诊断时和每个里程碑间隔（1 年、2 年、3 年后）计算虚弱指数评分。在基线和每个里程碑间隔评估虚弱与总生存（OS）的关联，以及随时间恶化虚弱状态的相关因素。共有 4617 名患者纳入研究。在基线时，39%的患者被归类为中度虚弱或重度虚弱。在那些有 3 年随访的患者中，93%的患者在诊断后出现虚弱分类改变（78%的患者在随访期间至少有一个时间点改善，72%的患者恶化）。在里程碑分析中，随着时间的推移，诊断时的虚弱对 OS 的预测能力下降（哈雷尔 C 统计量在诊断时为 0.65，在 1 年时为 0.63，在 2 年时为 0.62，在 3 年时为 0.60），并且低于每个里程碑间隔的当前虚弱状态。我们的研究是首次证明老年人 MM 中虚弱的动态本质。虚弱可能随时间改善或恶化。当前的虚弱状态是预后的更好预测指标，而不是诊断时的虚弱状态，这表明在这个高危患者群体中需要重新测量。
