Kategorie: Mnohočetný myelom
Téma: Myeloma and other monoclonal gammopathies - Clinical (Poster)
Číslo abstraktu: P354
Autoři: Roberto Mina; MD Alessandra Larocca; M.D. Massimo Offidani; MD Sara Bringhen; M.D. Alessia La Fauci; prof. MUDr. Roman Hájek, CSc.; MD Vittorio Montefusco; Dr. Annamaria Brioli; prof. M.D. Caterina Musolino; M.D. Antonietta Pia Falcone; Dr. Agostina Siniscalchi; Chiara (Clara) Pautasso; Tommasina Guglielmelli; Dott.ssa Iolanda Donatella Vincelli; Prof. MD Anna Marina Liberati; Vittorio E. Muccio; M.D. Patrizia Caraffa; Giulia Benevolo; Fabiana Gentilini; M.D. Stefano Pulini; Doc.MUDr. Luděk Pour, Ph.D.; MD Pellegrino Musto; MD Maria Teresa Petrucci; MD Pieter Sonneveld, PhD.; MD Mario Boccadoro; MD Antonio P. Palumbo
Background: Multiple myeloma is a neoplastic disease typical of elderly patients and aging is associated with worse survival. Elderly patients are highly heterogeneous. Aging and frailty have a negative impact on treatment tolerance and outcome of cancer patients. A geriatric assessment can better define patient status and help physicians tailor treatment.
Aims: The primary endpoint was to define a frailty score and assess its impact on outcome and toxicity. The secondary endpoint was to assess its value in subgroup of patients defined at high risk by International Staging System (ISS) and Fluorescence In Situ Hybridization (FISH).
Methods: Newly diagnosed multiple myeloma (NDMM) patients enrolled in 3 prospective trials including lenalidomide, bortezomib or carfilzomib were retrospectively analyzed. At diagnosis, a geriatric assessment was performed to assess co-morbidities (Charlson index), cognitive and functional conditions [Activity of Daily Living (ADL) and Instrumental Activity of Daily living (IADL) scores].
Results: We assessed 869 NDMM elderly patients. The prognostic role of age (‹75, 75-80, ›80 years), Charlson (≤1, ≥2), ADL (›4,≤4) and IADL (›5, ≤5) indices on overall survival (OS) was investigated using the Cox proportional hazard model. An additive frailty score was calculated (range 0-5) and three groups of patients were identified: fit (score=0, 39%); unfit (score=1, 31%), and frail (score ≥2, 30%). Progression-free survival (HR=1.68, CI 1.31-2.15, p‹0.001) and OS (HR=3.57, CI 2.37-5.39, p‹0.001) were significantly shorter for frail patients compared with fit patients. In a Cox’s model including ISS, FISH risk group and type of therapy (lenalidomide versus no lenalidomide), frail patients showed a higher risk of disease progression (HR 1.48, CI 1.15-1.92, p=0.003) and death (HR 2.88, CI 1.88-4.40, p‹0.001). The risks of grade 3 or higher non-hematologic adverse events (HR 1.57, CI 1.12-2.19, p=0.008) and drug discontinuation (HR 2.21, CI 1.57-3.09, p‹0.001) were higher for frail patients. The cumulative incidence of non-hematologic grade 3 or higher adverse events was higher for frail patients, and 4-month rate was 7.4% in fit and 19.2% in frail patients. The combination of the frailty score with ISS staging significantly improved risk assessment.
Summary/Conclusion: This simple score system based on age and geriatric assessment is able to identify frail patients at higher risk of toxicities and with a poor outcome. This approach should be used in the clinical practice to improve patient outcome and quality of life, reducing adverse events and health-care related costs.
Keywords: Diagnosis, Elderly, Multiple myeloma, Prognostic groups
Datum přednesení příspěvku: 13. 6. 2014