A simple frailty score that combines age, Charlson Comorbidity Index (CCI), and ECOG performance status was predictive of clinical outcomes among patients with transplant-ineligible multiple myeloma enrolled in the phase 3 FIRST trial.

A retrospective study of 1618 patients was conducted to see if outcomes varied according to frailty scores. Researchers compared this frailty assessment with the EQ-5D quality-of-life questionnaire.

In the algorithm, patients are given a score based on age (≤75=0, 76-80=1, >80=2), CCI (≤1=0, >1=1), and ECOG performance status (0=0, 1=1, ≥2=2). A score of 0 to 1 was considered nonfrail and a score of 2 or more was considered frail. In this simplified frailty assessment, patients were classified as frail (49%) or not frail (51%).

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Looking at this simplified score compared with the EQ-5D questionnaire, 65% of patients were classified into the same frailty group, 32% had a 1-level difference, and 3% had a 2-level difference.

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Patients considered to be frail had significantly lower overall response rate compared with nonfrail patients (72% vs 79%; P =.0002). In addition, progression-free survival (median 19.4 vs 24.0 months; P <.0001) and overall survival (median 42.1 vs 70.1 months; P <.0001) were also worse among frail compared with nonfrail patients.

According to the researchers, prognostic assessment was improved when combining frailty and International Staging System (ISS) stage.

Frail patients had a shorter time to premature discontinuation not due to disease progression or death, and had a high risk for developing grade 3/4 hematologic treatment-emergent adverse events.

“It is interesting to hypothesize that the use of a frailty scale based on age, comorbidities, and physical functioning could allow for better discrimination between elderly patients compared with evaluations based on age only,” the researchers wrote. “The prognostic ability of the frailty scale described here was demonstrated by further subdividing patients by ISS stage, and was a sensitive and easy-to-use predictor of survival.”


Facon T, Dimopoulos MA, Meuleman N, et al. A simplified frailty scale predicts outcomes in transplant-ineligible patients with newly diagnosed multiple myeloma treated in the FIRST (MM-020) trial [published online August 19, 2019]. Leukemia. doi: 10.1038/s41375-019-0539-0