Frailty in multiple myeloma: the need for harmony to prevent doing harm
Menée à partir des données de deux essais cliniques incluant au total 2 372 patients atteints d'un myélome et non éligibles à une greffe de cellules souches hématopoïétiques, cette étude évalue la performance d'un algorithme, intégrant le statut de performance de l'Organisation Mondiale de la Santé, le système de stadification international, l'âge et le niveau sérique de la protéine C-réactive, pour prédire la survie des patients et orienter la décision thérapeutique
In the past decade, an expanded treatment armamentarium has led to impressive improvements in the prognosis of older patients with multiple myeloma who are ineligible for autologous stem-cell transplantation. The extent of this improvement however, is more notable in younger patients than in older patients, probably because of biological ageing. Ageing is characterised by a progressive loss of physiological reserves leading to impaired organ function, of which frailty is the phenotype. In frail patients with multiple myeloma, drugs cause more adverse events than in non-frail patients, sometimes leading to discontinuation of therapy, with a negative effect on outcome. The International Myeloma Working Group (IMWG) has developed an index to identify frail patients who might have worse overall survival and progression-free survival, increased incidence of grade III–IV non-haematological toxicity, and discontinuation rate. The score is based on age (≤75 years, 76–80 years, or >80 years), the Charlson Comorbidity Index (≤1 or >1), the Activities of Daily Living (ADL; >4 or ≤4), and instrumental ADL (IADL; >5 or ≤5), and has been validated in a separate cohort of patients. Patients defined as frail with the IMWG frailty index have greater functional impairments and loss of muscle mass than non-frail patients, indicating that the index reflects biological frailty.
The Lancet Haematology , commentaire, 2018