The international myeloma working group frailty score is the currently most used frailty score in multiple myeloma care but it requires ADL and IADL besides age and comorbidities to calculate that score and ADL and IADL are not always available in clinical practice. So we investigated whether the WHO performance could be a proxy for a physical functioning marker for ADL and IADL.
Did you find it was a suitable proxy?
Yes, based on the WHO performance in addition to age and comorbidities we defined a frailty score by proxy and it was predictive for overall survival, also for grade 3 or higher toxicity as well as adverse events and infections and also for a trend towards high discontinuation rate in the frail. But it was not predictive for progression free survival.
What are the common complications that occur with multiple myeloma?
Normally we see a lot of infections or renal failure, hypoglycaemia and infections were more prevalent in the frail and unfit as compared to the fit. But haematological toxicity adverse events were similar across the three groups.
How can we advise clinicians to manage these?
This frailty score, as well as the IMWG frailty score, is not discriminative enough to change treatment but it’s good that you have a baseline assessment for those so that you can put them in a little bit of a box. These patients really frail we must take care of those patients or look after them more closely. So it’s not to change treatment but I hope we can further improve it by adding other variables which are also independently predictive so we can better predict and we can change treatments for them in the future.
What else would you like to include in the score in the future?
What we are doing in this cohort of patients is we also look at the self-reported physical functioning so patient reported outcomes. That’s a good thing, maybe, to incorporate.
Is there anything else you’d like to mention?
This proxy frailty score we want to validate this in another cohort of newly diagnosed multiple myeloma patients to see whether it is really predictive. That is future work in the next couple of years.