Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores

Abstract

This first validation of the International Myeloma Working Group geriatric assessment in 125 newly diagnosed multiple myeloma patients was performed using the International Myeloma Working Group score based on age, the Charlson Comorbidity Index and cognitive and physical conditions (Activities of Daily Living / Instrumental Activities of Daily Living) to classify patients as fit, intermediate-fit or frail. We verified the International Myeloma Working Group score's impact on outcome, and whether additional tools complement it. Since our prior analyses determined renal, lung and Karnofsky performance impairment as multivariate risks, and the inclusion of frailty, age and cytogenetics complements this, we included the revised myeloma comorbidity index, the Charlson Comorbidity Index, the Hematopoietic Cell Transplantation-Comorbidity Index and the Kaplan-Feinstein Index in this assessment. Multivariate analysis confirmed cytogenetics, Activities of Daily Living, Instrumental Activities of Daily Living and the Charlson Comorbidity Index as risks: 3-year overall survival for fit, intermediate-fit and frail patients was 91%, 77% and 47%, respectively. Using the Charlson Comorbidity Index, the Hematopoietic Cell Transplantation-Comorbidity Index, the Kaplan-Feinstein Index and the revised Myeloma Comorbidity Index allowed us to define fit and frail patients with distinct progression-free and overall survival rates, with the most pronounced differences evidenced via the International Myeloma Working Group score, the Charlson Comorbidity Index and the revised Myeloma Comorbidity Index. Since the Charlson Comorbidity Index is included in the International Myeloma Working Group score, we propose the latter and the revised Myeloma Comorbidity Index for future frailty measurements. Both are useful instruments for identifying myeloma patients with a geriatric risk profile and have a strong prognostic value for functional decline and overall survival. The study was registered as: (clinicaltrials.gov Identifier: 00003686).

Trial registration: ClinicalTrials.gov NCT00003686.

Copyright© Ferrata Storti Foundation.

Figures

Figure 1.

Kaplan-Meier estimates for progression-free survival (PFS) (n=125) according to different comorbidity scores [P-values; log-rank test]. (A) PFS in our patients divided into fit, intermediate-fit and frail patients showed group differences between both fitter patient groups and frail patients using the IMWG score. (B) PFS according to the R-MCI revealed better group distinctions between fit, intermediate-fit and frail patents. (C–E) PFS according to CCI risk groups again showed significant difference, whereas these were undetectable with the use of both HCT-CI (D) and Kaplan-Feinstein (E).

Figure 2.

Kaplan-Meier estimates for overall survival (OS) (n=125) according to different comorbidity scores [P-values; log-rank test]. (A) Overall survival (OS) according to the IMWG score assessed with our MM patient cohort showed improved OS for patients classified as fit (low-risk) or intermediate-fit (intermediate-risk) vs. those determined frail (high-risk). OS for the fit and intermediate-fit group was slightly, but insignificantly different. (B) OS according to the R-MCI showed improved survival of fit (low-risk) vs. intermediate-fit or frail (high-risk) patients. Differences between these 3 groups of fit, intermediate-fit and frail patients were more distinct compared to the IMWG score. (C–E) OS according to the CCI, dividing patients into two groups with CCI <2 vs. CCI ≥2 comorbidities, revealed significant OS differences, which were more pronounced than fit vs. frail patients assessed via HCT-CI (D) or Kaplan-Feinstein (E).