Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA.
Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Curr Oncol Rep. 2024 Jul;26(7):744-753. doi: 10.1007/s11912-024-01545-2. Epub 2024 May 18.
As the treatment landscape for multiple myeloma (MM) continues to expand at a rapid pace, management of older adults and frail patients becomes increasingly challenging. As these patients have traditionally been underrepresented on clinical trials, there is limited guidance on the optimal approach to frail patients with newly diagnosed multiple myeloma (NDMM) or relapsed and refractory multiple myeloma (RRMM).
Frailty is an independent predictor of tolerability and response to antineoplastic treatment. Stringent eligibility criteria have often excluded these patients, but recently some large trials have included frailty sub-analyses to help guide management. In general, triplet regimens are preferred to doublet regimens in this population and enrollment on a clinical trial should be prioritized when possible. In this review, we summarize the MM frailty scoring tools that have been developed to identify and assess this vulnerable population. We present the clinical trials over the past decade that have enrolled frail patients and/or have included subgroup analyses to help elucidate the response and tolerability of different regimens in this underrepresented group. We provide practical advice regarding assessment and management of frail patients NDMM and RRMM.
随着多发性骨髓瘤（MM）的治疗领域迅速扩展，老年患者和虚弱患者的管理变得越来越具有挑战性。由于这些患者在临床试验中代表性不足，因此对于新诊断的多发性骨髓瘤（NDMM）或复发性和难治性多发性骨髓瘤（RRMM）的虚弱患者，最佳治疗方法的指导有限。
虚弱是抗肿瘤治疗耐受性和反应的独立预测因素。严格的入选标准通常将这些患者排除在外，但最近一些大型试验进行了虚弱亚组分析，以帮助指导治疗。一般来说，在该人群中，三联方案优于二联方案，并且在可能的情况下，应优先参加临床试验。在这篇综述中，我们总结了已经开发出来的用于识别和评估这一脆弱人群的 MM 虚弱评分工具。我们介绍了过去十年中招募虚弱患者的临床试验，以及进行亚组分析以帮助阐明不同方案在这一代表性不足的群体中的反应和耐受性。我们提供了关于评估和管理 NDMM 和 RRMM 虚弱患者的实用建议。
