This DAFI looked at retrospective data from 2 cohorts, 1 of newly diagnosed MM patients, aged older than 65, and the other comprised of those who did not have MM. The derivation cohort included over 2.6 million patients without cancer.

The DAFI that was developed for this study took into account 25 variables that assessed patient’s functional status, chronic conditions, ability to perform activities of daily living, general health, and mental health, among other parameters. DAFI scores ranged from 0.0 to 1.0 where 0.0 corresponded to “no frail deficits noted”. The patient information was obtained from the Medicare Health Outcomes Survey (MHOS), which collects self-reported symptoms, functional status, and health-related quality of life information from Medicare beneficiaries who are enrolled in Medicare Advantage health plans. The objective was to determine if the frailty status identified in this study was associated with survival of older patients with MM.5


Continue Reading

The median age in each cohort was 74 years for patients without MM and 76 years for those with MM. The mean frailty index for patients without cancer was 0.23 (standard deviation [SD], 0.17), and it was found to be strongly correlated with chronological age. Among these patients, each 10% increase in frailty index was associated with a 40% increased risk for death (adjusted HR [aHR], 1.397; 95% CI, 1.397 to 1.399; P < .001).

Related Articles

For patients with MM, the mean frailty index was higher, at 0.28 (SD, 0.17), with advancing chronological age only weakly correlated with an increase in deficits. For patients with MM, a 10% increase in frailty index was associated with a 16% increased risk for death. (aHR, 1.159, 95% CI, 1.080 to 1.244; P < .001). In a multivariable analysis performed in patients with MM, a frail status was associated with a 63% increased risk for death (aHR, 1.63; 95% CI, 1.33 to 2.33, P < .001).5

Overall, the study by Mian and coauthors demonstrated that advancing chronological age does not always correlate strongly with an increase in deficits or frail status. The authors disclosed that this study only looked at overall survival and not rates of toxicity or hospitalization.  But in general, there is a consensus that a more personal approach is necessary to assess a patient’s frailty status prior to deciding on aggressive treatment for MM. This will help to optimize outcomes for this particular cohort and potentially help clinicians better predict survival.  

References

  1. Abel GA, Klepin HD. Frailty and the management of hematologic malignancies. Blood. 2018;131(5):515-524.
  2. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433-441.
  3. Kumar SK, Raikumar SV, Dispenzieri A, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood. 2008;111(5):2516-2520.
  4. Larocca A, Palumbo A. How I treat fragile myeloma patients. Blood. 2015;126(19):2179-2185.
  5. Mian HS, Wildes TM, Fiala MA. Development of a Medicare health outcomes survey deficit-accumulation frailty index and its application to older patients with newly diagnosed multiple myeloma [published online July 25]. Clin Cancer Inform. doi: 10.1200/CCI.18.00043
  6. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002;2(1):1-8.
  7. Pozzi S, Marcheselli L, Bari A, et al. Survival of multiple myeloma patients in the era of novel therapies confirms the improvement in patients younger than 75 years: a population-based analysis. Br J Haematol. 2013;163(1):40-46.
  8. Rosko AE, Huang Y, Benson DM, et al. Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant [published online July 6, 2018]. J Geriatr Oncol. doi: 10.1016/j.jgo.2018.05.015