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Lipof JJ, Abdallah N, Lipe B. Personalized Treatment of Multiple Myeloma in Frail Patients. Curr Oncol Rep 2024:10.1007/s11912-024-01545-2. [PMID: 38761302 DOI: 10.1007/s11912-024-01545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE OF REVIEW As the treatment landscape for multiple myeloma (MM) continues to expand at a rapid pace, management of older adults and frail patients becomes increasingly challenging. As these patients have traditionally been underrepresented on clinical trials, there is limited guidance on the optimal approach to frail patients with newly diagnosed multiple myeloma (NDMM) or relapsed and refractory multiple myeloma (RRMM). RECENT FINDINGS Frailty is an independent predictor of tolerability and response to antineoplastic treatment. Stringent eligibility criteria have often excluded these patients, but recently some large trials have included frailty sub-analyses to help guide management. In general, triplet regimens are preferred to doublet regimens in this population and enrollment on a clinical trial should be prioritized when possible. In this review, we summarize the MM frailty scoring tools that have been developed to identify and assess this vulnerable population. We present the clinical trials over the past decade that have enrolled frail patients and/or have included subgroup analyses to help elucidate the response and tolerability of different regimens in this underrepresented group. We provide practical advice regarding assessment and management of frail patients NDMM and RRMM.
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Affiliation(s)
- Jodi J Lipof
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Nadine Abdallah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brea Lipe
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA.
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2
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Wildes TM. Exploring Indicators of Vulnerability in Older Adults With Newly Diagnosed Multiple Myeloma. JCO Clin Cancer Inform 2024; 8:e2400013. [PMID: 38507666 DOI: 10.1200/cci.24.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
New publication provides insights into the impact of disability on outcomes in older adults with multiple myeloma.
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Affiliation(s)
- Tanya M Wildes
- University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE
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3
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Frank B, Ihorst G, Herget G, Schäfer H, Neubauer J, Calba MA, Textor D, Möller MD, Wenger S, Jung J, Waldschmidt J, Miething C, Rassner M, Greil C, Wäsch R, Engelhardt M. Multidisciplinary tumor board analysis: validation study of a central tool in tumor centers. Ann Hematol 2023; 102:603-611. [PMID: 36464695 PMCID: PMC9734518 DOI: 10.1007/s00277-022-05051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The established standard to ensure state-of-the-art cancer treatment is through multidisciplinary tumor boards (TBs), although resource- and time-intensive. In this validation study, the multiple myeloma (MM)-TB was reexamined, aiming to validate our previous (2012-2014) results, now using the TB data from March 2020 to February 2021. We assessed MM-TB protocols, physicians' documentation, patient, disease, remission status, progression-free survival (PFS), and overall survival (OS) as left-truncated survival times. Moreover, TB-adherence, level of evidence according to grade criteria, time requirements, study inclusion rates, and referral satisfaction were determined. Within a 1-year period, 312 discussed patients were documented in 439 TB protocols. Patient and disease characteristics were typical for comprehensive cancer centers. The percentages of patients discussed at initial diagnosis (ID), with disease recurrence or in need of interdisciplinary advice, were 39%, 28%, and 33%, respectively. Reasons for the MM-TB presentation were therapeutic challenges in 80% or staging/ID-defining questions in 20%. The numbers of presentations were mostly one in 73%, two in 20%, and three or more in 7%. The TB adherence rate was 93%. Reasons for non-adherence were related to patients' decisions or challenging inclusion criteria for clinical trials. Additionally, we demonstrate that with the initiation of TBs, that the number of interdisciplinarily discussed patients increased, that TB-questions involve advice on the best treatment, and that levels of compliance and evidence can be as high as ≥ 90%. Advantages of TBs are that they may also improve patients', referrers', and physicians' satisfaction, inclusion into clinical trials, and advance interdisciplinary projects, thereby encouraging cancer specialists to engage in them.
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Affiliation(s)
- Benedikt Frank
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany
| | - Gabriele Ihorst
- grid.5963.9Clinical Trials Unit, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Herget
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Clinic for Orthopedics and Trauma Surgery, Department of Surgery, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Henning Schäfer
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Clinic for Radiotherapeutics, University of Freiburg, Freiburg, Germany
| | - Jakob Neubauer
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Department of Radiology, University of Freiburg, Freiburg, Germany
| | - Marc-Antoine Calba
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany ,grid.5963.9Pathology, University of Freiburg, Freiburg, Germany
| | - Daniel Textor
- Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Mandy-Deborah Möller
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Sina Wenger
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Johannes Jung
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Johannes Waldschmidt
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Cornelius Miething
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Michael Rassner
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Christine Greil
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Ralph Wäsch
- grid.5963.9Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106 Freiburg, Baden-Württemberg Germany ,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Monika Engelhardt
- Department of Internal Medicine I, Focus On Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstraße 53, 79106, Freiburg, Baden-Württemberg, Germany. .,Tumor Center Freiburg, Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany.
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4
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Revannasiddaiah S, Nagaraju PRVMA, Palassery R, Jagadish A, Maka VV, Kilara N, Rondelli D, Devadas SK. The limited use of autologous hematopoietic stem cell transplant for fit older patients with multiple myeloma in India: a retrospective analysis. J Egypt Natl Canc Inst 2022; 34:21. [DOI: 10.1186/s43046-022-00123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multiple myeloma (MM) predominantly affects older patients; many of whom do not undergo autologous hematopoietic stem cell transplant (AHSCT) despite the associated survival benefits. This study was conceived to investigate the patterns of AHSCT among MM patients with due regard to their age and standardized fitness assessments.
Methods
Fitness scores as per the hematopoietic stem cell transplant-comorbidity index (HSCT-CI) and risk scores as per the revised-myeloma comorbidity index (R-MCI) of MM patients treated between January 2017 and December 2019 were analyzed to assess fitness for AHSCT. Proportions of patients who underwent AHSCT were calculated with regard to age and fitness for AHSCT.
Results
Of the 81 eligible patient records with a median age of 62 years, the HSCT-CI classified 79.6% and 77.8% of patients aged ≤65 years and >65 years as AHSCT eligible (p 1). Using the R-MCI, 96.3% and 81.5% of patients aged ≤65 years and >65 years, respectively, were classified as eligible for AHSCT (p 0.0381). Overall, patients aged ≤65 years underwent AHSCT with a greater frequency compared to those aged >65years (38.9 vs. 14.8%, p 0.0402). Irrespective of the age group, there was a statistically significant difference (p 0.0167) in terms of survival which favored those who underwent AHSCT.
Conclusions
Both the HSCT-CI and the R-MCI revealed that nearly 80% of patients aged >65 years were fit enough to receive AHSCT. However, far fewer patients of this age group underwent AHSCT. We propose that the routine inclusion of objective fitness assessment could ensure that fit older patients undergo AHSCT and thus do not miss out on the benefits of the same.
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Goede V, Neuendorff NR, Schulz RJ, Hormigo AI, Martinez-Peromingo FJ, Cordoba R. Frailty assessment in the care of older people with haematological malignancies. THE LANCET HEALTHY LONGEVITY 2021; 2:e736-e745. [DOI: 10.1016/s2666-7568(21)00184-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 02/03/2023]
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6
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Gengenbach L, Graziani G, Reinhardt H, Rösner A, Braun M, Möller MD, Greil C, Wäsch R, Engelhardt M. Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors. Cancers (Basel) 2021; 13:4320. [PMID: 34503130 PMCID: PMC8430818 DOI: 10.3390/cancers13174320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023] Open
Abstract
Treatment of relapsed/refractory multiple myeloma (RRMM) is more complex today due to the availability of novel therapeutic options, mostly applied as combination regimens. immunotherapy options have especially increased substantially, likewise the understanding that patient-, disease- and treatment-related factors should be considered at all stages of the disease. RRMM is based on definitions of the international myeloma working group (IMWG) and includes biochemical progression, such as paraprotein increase, or symptomatic relapse with CRAB criteria (hypercalcemia, renal impairment, anemia, bone lesions). When choosing RRMM-treatment, the biochemical markers for progression and severity of the disease, dynamic of disease relapse, type and number of prior therapy lines, including toxicity and underlying health status, need to be considered, and shared decision making should be pursued. Objectively characterizing health status via geriatric assessment (GA) at each multiple myeloma (MM) treatment decision point has been shown to be a better estimate than via age and comorbidities alone. The well-established national comprehensive cancer network, IMWG, European myeloma network and other national treatment algorithms consider these issues. Ideally, GA-based clinical trials should be supported in the future to choose wisely and efficaciously from available intervention and treatment options in often-older MM adults in order to further improve morbidity and mortality.
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7
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Şahin T, Turgutkaya A, Kadıköylü G, Bolaman AZ, Yavaşoğlu İ. Investigation of demographic features, performance, comorbidity status and mortality causes among multiple myeloma patients: real-life data. Expert Rev Hematol 2021; 14:1147-1153. [PMID: 34319819 DOI: 10.1080/17474086.2021.1962279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The demographic characteristics, performance status, frequency of comorbidities and survival rate of patients with multiple myeloma (MM) show variability geographically and different risk scoring systems have been used to assess this population. Here, we present data from a Turkish cohort, focusing on identifying similarities and differences, relative to other reports in the literature. RESEARCH DESIGN AND METHODS A total of 310 patients diagnosed with MM were enrolled. Their demographic characteristics were investigated retrospectively. For performance assessment; the ECOG-IMWG Myeloma Frailty Score, R-MCI and HCT-SCI scoring indexes were used. PFS and OS periods, as well as the causes of deaths, were determined. RESULTS The mean age of all study participants was 65 ± 10 years. The mean PFS and OS periods were 24.14± 26.11 and 65.3 ± 4.4 months, respectively. The median R-MCI, CCI and HCT-CI scores were five, four and three points, respectively. Myeloma-related complications were the leading cause of death, with a frequency of 51%. CONCLUSION Among the scoring systems utilised, R-MCI was more convenient to apply due to its ease of use and practicality. Our study supports the heterogeneous course of myeloma and highlights geographic differences including comorbidities, causes of death and overall survival.
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Affiliation(s)
- Tuğba Şahin
- Internal Medicine Department, M.D, Adnan Menderes University, Efeler, Aydın, TURKEY
| | - Atakan Turgutkaya
- Hematology Department, M.D.(Hematology Specialist), Adnan Menderes University, Efeler, Aydın, TURKEY
| | - Gürhan Kadıköylü
- Hematology and Bone Marrow Transplantation Department, Prof Dr, Kent Hospital, Çiğli-İZMİR, Turkey
| | | | - İrfan Yavaşoğlu
- Hematology Department, Prof.Dr, Adnan Menderes University, Turkey
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8
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Auner HW, Gavriatopoulou M, Delimpasi S, Simonova M, Spicka I, Pour L, Dimopoulos MA, Kriachok I, Pylypenko H, Leleu X, Doronin V, Usenko G, Hajek R, Benjamin R, Dolai TK, Sinha DK, Venner CP, Garg M, Stevens DA, Quach H, Jagannath S, Moreau P, Levy M, Badros A, Anderson LD, Bahlis NJ, Facon T, Mateos MV, Cavo M, Chai Y, Arazy M, Shah J, Shacham S, Kauffman MG, Richardson PG, Grosicki S. Effect of age and frailty on the efficacy and tolerability of once-weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma. Am J Hematol 2021; 96:708-718. [PMID: 33755235 DOI: 10.1002/ajh.26172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022]
Abstract
Elderly and frail patients with multiple myeloma (MM) are more vulnerable to the toxicity of combination therapies, often resulting in treatment modifications and suboptimal outcomes. The phase 3 BOSTON study showed that once-weekly selinexor and bortezomib with low-dose dexamethasone (XVd) improved PFS and ORR compared with standard twice-weekly bortezomib and moderate-dose dexamethasone (Vd) in patients with previously treated MM. This is a retrospective subgroup analysis of the multicenter, prospective, randomized BOSTON trial. Post hoc analyses were performed to compare XVd versus Vd safety and efficacy according to age and frailty status (<65 and ≥65 years, nonfrail and frail). Patients ≥65 years with XVd had higher ORR (OR 1.77, p = .024), ≥VGPR (OR, 1.68, p = .027), PFS (HR 0.55, p = .002), and improved OS (HR 0.63, p = .030), compared with Vd. In frail patients, XVd was associated with a trend towards better PFS (HR 0.69, p = .08) and OS (HR 0.62, p = .062). Significant improvements were also observed in patients <65 (ORR and TTNT) and nonfrail patients (PFS, ORR, ≥VGPR, and TTNT). Patients treated with XVd had a lower incidence of grade ≥ 2 peripheral neuropathy in ≥65 year-old (22% vs. 37%; p = .0060) and frail patients (15% vs. 44%; p = .0002). Grade ≥3 TEAEs were not observed more often in older compared to younger patients, nor in frail compared to nonfrail patients. XVd is safe and effective in patients <65 and ≥65 and in nonfrail and frail patients with previously treated MM.
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Affiliation(s)
- Holger W. Auner
- The Hugh and Josseline Langmuir Centre for Myeloma Research Imperial College London London UK
| | - Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens Athens Greece
| | | | - Maryana Simonova
- Institute of Blood Pathology & Transfusion Medicine of National Academy of Medical Sciences of Ukraine Lviv Ukraine
| | - Ivan Spicka
- Charles University and General Hospital Prague Czech Republic
| | - Ludek Pour
- University Hospital Brno Brno Czech Republic
| | | | | | - Halyna Pylypenko
- Department of Hematology Cherkassy Regional Oncological Center Cherkassy Ukraine
| | - Xavier Leleu
- Department of Hematology CHU la Miletrie and Inserm CIC 1402 Poitiers France
| | - Vadim Doronin
- City Clinical Hospital #40 Moscow Russian Federation
| | - Ganna Usenko
- City Clinical Hospital No. 4 of Dnipro City Council Dnipro Ukraine
| | - Roman Hajek
- Department of Hemato‐oncology University Hospital Ostrava, University of Ostrava Ostrava Czech Republic
| | | | | | - Dinesh Kumar Sinha
- State Cancer Institute, Indira Gandhi Institute of Medical Sciences Patna India
| | | | - Mamta Garg
- University Hospitals of Leicester NHS Trust Leicester UK
| | | | - Hang Quach
- University of Melbourne, St. Vincent's Hospital Melbourne Victoria Australia
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai New York New York USA
| | | | - Moshe Levy
- Baylor University Medical Center Dallas Texas USA
| | - Ashraf Badros
- University of Maryland, Greenebaum Comprehensive Cancer Center Baltimore Maryland USA
| | - Larry D. Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center Dallas Texas USA
| | - Nizar J. Bahlis
- University of Calgary, Charbonneau Cancer Research Institute Calgary Alberta Canada
| | - Thierry Facon
- CHU Lille Service des Maladies du Sang F‐59000 Lille France
| | | | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine Bologna Italy
| | - Yi Chai
- Karyopharm Therapeutics Inc. Newton Massachusetts USA
| | - Melina Arazy
- Karyopharm Therapeutics Inc. Newton Massachusetts USA
| | - Jatin Shah
- Karyopharm Therapeutics Inc. Newton Massachusetts USA
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Scheubeck S, Ihorst G, Schoeller K, Holler M, Möller MD, Reinhardt H, Wäsch R, Engelhardt M. Comparison of the prognostic significance of 5 comorbidity scores and 12 functional tests in a prospective multiple myeloma patient cohort. Cancer 2021; 127:3422-3436. [PMID: 34061991 DOI: 10.1002/cncr.33658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Because of the various therapeutic options available for multiple myeloma (MM), remarkable interest exists today in individualized therapeutic concepts based on patients' fitness. The main objectives of this study were to compare different comorbidity scores and functional tests with respect to their impact on survival (overall survival [OS] and progression-free survival [PFS]); develop a time-efficient, MM-specific functional assessment (FA); and evaluate changes in patients' FA during treatment. METHODS The authors performed a prospective FA in 266 consecutive patients with MM at their initial diagnosis. This included 5 comorbidity scores and 12 commonly used geriatric functional tests. To evaluate changes in the course of treatment, the authors reassessed these 17 tests after ≥6 months. The entire analysis included 7327 FA tests. RESULTS On the basis of univariate and multivariate Cox regression analyses, the authors identified 4 of the 17 evaluated scores and functional tests as most relevant: the Revised Myeloma Comorbidity Index (R-MCI), Activity of Daily Living (ADL), the Mini-Mental State Examination (MMSE), and the quality-of-life 12-Item Short Form Health Survey Physical Composite Scale (SF-12 PCS). These showed precise group differences for fit, (intermediate-fit), and frail patients in OS and PFS: the 3-year OS rates were 90%, 74%, and 43% via the R-MCI for fit, intermediate-fit, and frail patients, respectively (P = .0006); 80% and 66% via the ADL for fit and frail patients, respectively (P = .0159); 78% and 48% via the MMSE for fit and frail patients, respectively (P = .0001); and 86% and 66% via the SF-12 PCS for fit and frail patients, respectively (P = .0091). In follow-up analyses, 16 of 17 FA tests improved, mostly in younger patients (<70 years old) and responding patients (partial remission or better). CONCLUSIONS Patients may recover from functional and physical limitations under applied MM therapy. The newly established MM-specific FA (via the R-MCI, ADL, MMSE, and SF-12 PCS) allows a precise evaluation of the prognosis and risk status in MM. Its use may improve treatment tolerability and should be validated to individualize MM treatment decisions in the future. LAY SUMMARY The authors performed a prospective functional assessment (FA) in 266 consecutive patients with multiple myeloma at their initial diagnosis. On the basis of univariate and multivariate Cox regression analyses, the authors identified 4 of 17 initially evaluated scores and functional tests as most relevant: the Revised Myeloma Comorbidity Index, Activity of Daily Living, the Mini-Mental State Examination, and the quality-of-life 12-Item Short Form Health Survey Physical Composite Scale. The authors checked the stability of the final model by applying forward and stepwise selection. To evaluate changes in the course of treatment, they reassessed these 17 tests in 165 patients after ≥6 months: 16 of the 17 FA tests improved, mostly in younger patients (<70 years old) and responding patients (partial remission or better).
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Affiliation(s)
- Sophia Scheubeck
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja Schoeller
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Holler
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mandy-Deborah Möller
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heike Reinhardt
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I: Hematology and Oncology, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany
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10
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Engelhardt M, Ihorst G, Schumacher M, Rassner M, Gengenbach L, Möller M, Shoumariyeh K, Neubauer J, Farthmann J, Herget G, Wäsch R. Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures. BMC Cancer 2021; 21:173. [PMID: 33596881 PMCID: PMC7891134 DOI: 10.1186/s12885-021-07878-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs are resource-intensive. Outcome measures in these prior analyses had been survival (OS), MTB-adherence and -satisfaction, inclusion of patients into clinical trials and better cancer care. MAIN BODY A publication from Freytag et al. performed an analysis in multiple tumor entities and assessed the effect of number of MTBs. By matched-pair analysis, they compared response and OS of patients, whose cases were discussed in MTBs vs. those that were not. The analysis included 454 patients and 66 different tumor types. Only patients with > 3 MTBs showed a significantly better OS than patients with no MTB meeting. Response to treatment, relapse free survival and time to progression were not found to be better, nor was there any difference for a specific tumor entity with vs. without MTB discussions. An in-depth discussion of these results, with respect to the literature (PubMed search: "MTBs AND cancer") and within the author group, including statisticians specialized in data analysis of cancer patients and questions addressed in MTBs, was performed to interpret these findings. We conclude that the results by Freytag et al. are deceiving due to an "immortal time bias" that requires more careful data interpretation. CONCLUSIONS The result of Freytag et al. of a seemingly positive impact of higher number of MTBs needs to be interpreted cautiously: their presumed better OS in patients with > 3 MTB discussions is misleading, due to an immortal time bias. Here patients need to survive long enough to be discussed more often. Therefore, these results should not lead to the conclusion that more MTBs will "automatically" increase cancer patients' OS, rather than that the insightful discussion, at best in MTBs and with statisticians, will generate meaningful advice, that is important for cancer patients.
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Affiliation(s)
- Monika Engelhardt
- University of Freiburg Medical Center, Hematology & Oncology, Faculty of Medicine, Hugstetterstr. 53, 79106, Freiburg, Germany. .,Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany.
| | - Gabriele Ihorst
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany.,Clinical Trials Unit, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Martin Schumacher
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany.,Medical Biometry and Statistics (IMBI), University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Michael Rassner
- University of Freiburg Medical Center, Hematology & Oncology, Faculty of Medicine, Hugstetterstr. 53, 79106, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany
| | - Laura Gengenbach
- University of Freiburg Medical Center, Hematology & Oncology, Faculty of Medicine, Hugstetterstr. 53, 79106, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany
| | - Mandy Möller
- University of Freiburg Medical Center, Hematology & Oncology, Faculty of Medicine, Hugstetterstr. 53, 79106, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany
| | - Khalid Shoumariyeh
- University of Freiburg Medical Center, Hematology & Oncology, Faculty of Medicine, Hugstetterstr. 53, 79106, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany
| | - Jakob Neubauer
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany.,Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juliane Farthmann
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany.,Department of Obstetrics and Gynecology, University Medical Center, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Georg Herget
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany.,Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Ralph Wäsch
- University of Freiburg Medical Center, Hematology & Oncology, Faculty of Medicine, Hugstetterstr. 53, 79106, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Freiburg im Breisgau, Germany
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11
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Vaxman I, Visram A, Kumar S, Dispenzieri A, Buadi F, Dingli D, Lacy M, Muchtar E, Kapoor P, Hogan W, Hayman S, Leung N, Gonsalves W, Kourelis T, Warsame R, Berger T, Gertz MA. Autologous stem cell transplantation for multiple myeloma patients aged ≥ 75 treated with novel agents. Bone Marrow Transplant 2020; 56:1144-1150. [PMID: 33273658 DOI: 10.1038/s41409-020-01159-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Autologous stem cell transplantation (ASCT) has been used for treating multiple myeloma (MM) for over three decades and is generally reserved for patients younger than 65. Herein we report on outcomes of outpatient ASCT in a cohort of patients with MM aged ≥75 years. Between October 2005 and August 2020, 50 patients aged ≥75 years, received an ASCT at Mayo Clinic, Rochester. Median time from diagnosis to ASCT was 6.85 months (IQR 5.2-10.52) and 50%. received reduced intensity conditioning with melphalan 140 mg/m2. 48% of patients completed the ASCT without requiring hospitalization and 52% (n = 26) of patients required hospitalization with a median duration of hospital admission of 9 days (IQR 5-13). Reasons for hospitalization included fever or infection (32%), cardiac arrhythmia (36%), and dehydration (32%). Overall response rate was 100% with a complete response seen in 57% of patients. Median overall survival and progression free survival for the cohort were 82 months and 33 months, respectively. One patient died within 100 days of transplant representing a 2% 100-day mortality rate. ASCT is safe and efficacious in carefully selected MM patients aged 75 or above and we believe that age should not be an exclusion factor for ASCT in MM.
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Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center Petah, Tikvah, Israel.,Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Alissa Visram
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Francis Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center Petah, Tikvah, Israel.,Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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12
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Engelhardt M, Shoumariyeh K, Rösner A, Ihorst G, Biavasco F, Meckel K, von Metzler I, Theurich S, Hebart H, Grube M, Kull M, Bassermann F, Schäfer-Eckart K, Hoferer A, Einsele H, Rasche L, Wäsch R. Clinical characteristics and outcome of multiple myeloma patients with concomitant COVID-19 at Comprehensive Cancer Centers in Germany. Haematologica 2020; 105:2872-2878. [PMID: 33256391 PMCID: PMC7716370 DOI: 10.3324/haematol.2020.262758] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Monika Engelhardt
- Freiburg University Medical Center, Department of Internal Medicine I, Faculty of Medicine, University of Freiburg, Freiburg
- German Cancer Consortium (DKTK) Heidelberg, Heidelberg
| | - Khalid Shoumariyeh
- Freiburg University Medical Center, Department of Internal Medicine I, Faculty of Medicine, University of Freiburg, Freiburg
- German Cancer Consortium (DKTK) Heidelberg, Heidelberg
| | - Amelie Rösner
- Freiburg University Medical Center, Department of Internal Medicine I, Faculty of Medicine, University of Freiburg, Freiburg
| | - Gabriele Ihorst
- Clinical Trials Unit Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Francesca Biavasco
- Freiburg University Medical Center, Department of Internal Medicine I, Faculty of Medicine, University of Freiburg, Freiburg
- German Cancer Consortium (DKTK) Heidelberg, Heidelberg
| | - Katharina Meckel
- Medizinische Klinik und Poliklinik II, Julius- Maximilian-University of Würzburg, Würzburg
| | - Ivana von Metzler
- Universitätsklinik Frankfurt, Department of Hematology and Oncology, University of Franfurt, Frankfurt
| | - Sebastian Theurich
- LMU University Hospital München, Department of Internal Medicine III, Ludwig-Maximilian-University München, München
| | | | - Matthias Grube
- Universitätsklinik Regensburg, Department of Hematology and Oncology, University of Regensburg, Regensburg
| | - Miriam Kull
- Universitätsklinik Ulm, Department of Hematology and Oncology, Univeristy of Ulm, Ulm
| | - Florian Bassermann
- Florian Bassermann Klinikum rechts der Isar, Department of Hematology and Oncology, München
| | | | | | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Julius- Maximilian-University of Würzburg, Würzburg
| | - Leo Rasche
- Medizinische Klinik und Poliklinik II, Julius- Maximilian-University of Würzburg, Würzburg
| | - Ralph Wäsch
- Freiburg University Medical Center, Department of Internal Medicine I, Faculty of Medicine, University of Freiburg, Freiburg
- German Cancer Consortium (DKTK) Heidelberg, Heidelberg
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13
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Defining the vulnerable patient with myeloma-a frailty position paper of the European Myeloma Network. Leukemia 2020; 34:2285-2294. [PMID: 32555295 DOI: 10.1038/s41375-020-0918-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
As the treatment landscape continues to evolve towards the application of precision medicine in multiple myeloma (MM), there is a clear need to identify those patients who are at risk of not achieving the maximum benefit whilst exposed to the highest level of toxicity. This group of patients, defined as frail, is an unmet clinical need. However, how we define such a vulnerable group of patients with MM remains to be clarified. An integral aspect of this is to define the physiological age and capacity of patients with MM to deal with the burden of their disease and it's treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. A need to develop, test and validate clinical screening scores before their adoption into clinical practice is mandated. This position paper from the European Myeloma Network aims to review what is known about defining frailty in MM, and how we can advance this knowledge for the design of clinical trials and ultimately how we deliver treatment in the clinic.
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