To offer aggressive therapy to older patients, clinicians must identify the patient’s ability to tolerate treatment. A patient’s frailty has been determined to be associated with a higher likelihood of developing toxicities, a poor therapeutic response, and decreased survival.1,2

Multiple myeloma (MM) is a hematological malignancy, characterized by proliferation of malignant cells in the bone marrow. It affects 1 to 5 people per 100,000 individuals annually and is the second most common hematologic malignancy.3 The median age at diagnosis is 70 years, and because of an increase in life expectancy worldwide, the number of patients with MM is expected to increase considerably in the next 2 decades.4 Treatment for MM has progressed substantially with novel therapeutic agents being introduced, leading to improved progression-free survival and overall survival (OS). Unfortunately, clinicians are often reluctant to offer aggressive therapy to elderly patients, especially those who are aged 75 years and older, due to concern for increased risk for morbidity and mortality.5

This has led to a less demonstrable benefit noted in elderly patients treated with novel chemotherapy. Recent studies have highlighted the importance of targeting older patients in clinical studies to identify innovative approaches to improve outcomes in this patient population.3

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One barrier to studying novel therapies in elderly patients is the association of frailty with chronological age. Various frailty indices have been developed and utilized to evaluate patients prior to therapy initiation, but those tools are largely affected by chronological age, and do not take into account biologic age or functional status.

In a published study by Mian and colleagues, a frailty index was developed using retrospective biologic data to evaluate survival in newly diagnosed patients with MM.5

Using the Rockwood Accumulation of Deficits approach, where health status is quantified as a proportion of aging-associated deficits, the authors developed a deficit-accumulation frailty index (DAFI).  DAFIs have been validated in clinical trials in the past, but more recently have garnered support in chemotherapy trials.