Evaluation of Geriatric Assessment Tools in Elderly Patients with MM

Conference Correspondent - TON - ASH 2015 - Multiple Myeloma, Conference Correspondent

Geriatric assessment (GA) tools have been developed to help determine the capabilities and needs of elderly patients with multiple myeloma (MM). There are concerns that scoring tools developed in clinical trials may have limited applicability in the real-world treatment setting. In this study, researchers prospectively evaluated patients aged >65 years with symptomatic MM to evaluate several different GA tools (including the International Myeloma Working Group [IMWG] “frailty score” and the G8-geriatric assessment screening [GAS] tool) and comorbidity indices, along with standard disease-related prognostic factors.

At baseline, the median age of patients with a GA was 76 years (range, 66-92); 55% were males; 26% had ISS-1, 24% ISS-2, and 50% ISS-3. A total of 47% of patients received immunomodulator-based treatment, and 53% were treated with proteasome inhibitors. Median follow-up was 20 months. Two-year overall survival (OS) was 71%.

In univariate analyses of GA tools, several variables were found to have prognostic significance, including:

  • Number of falls in the past 6 months (0 vs ≥1; P = .002)
  • Lower extremity function (score <9 vs ≥9; P = .014)
  • Mini-nutritional assessment (score <11 vs ≥11; P = .014)
  • G8-GAS (score <12 vs ≥12; P <.001)
  • Karnofsky Index of Performance Status <50% (P <.001)
  • Eastern Cooperative Oncology Group Performance Status >2 (P = .04)
  • Mini-Mental State Examination (score ≥6 vs <6; P = .024)

In a multivariate analysis, which included ISS and age, number of falls in the past 6 months (0 vs ≥1; hazard ratio [HR], 4.7; P = .007) and score <12 in the G8-GAS tool (HR, 4.7; P = .004) were independent factors for survival.

Researchers concluded that in elderly myeloma patients, G8-GAS provides prognostic information related to the risk of early death and OS, independently from disease characteristics and the treatment type. Although the IMWG “frailty score” may be useful for patients fit to participate in clinical trials, this metric appeared to have limited prognostic utility in a real-world patient setting.

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Last modified: December 8, 2015