Geriatric Assessment to Predict Survival and Risk of Serious Adverse Events in Elderly Newly Diagnosed Multiple Myeloma Patients: A Multicenter Study in China
Yu-Ping Zhong1, Yi-Zhuo Zhang2, Ai-Jun Liao3, Su-Xia Li4, Chen Tian5, Jin Lu6
1 Department of Hematology, Beijing Chaoyang Hospital (West), Capital Medical University, Beijing University Clinical Research Institute, Beijing 100043, China
2 Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin Cancer Hospital, Tianjin 300000, China
3 Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
4 Department of Hematology, The People's Liberation Army 301 Hospital, Beijing 100853, China
5 Department of Hematology, The People's Liberation Army 304 Hospital, Beijing 100048, China
6 Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, Beijing 100044, China
Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xi Cheng District, Beijing 100044
Source of Support: None, Conflict of Interest: None
Background: Elderly multiple myeloma (MM) patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival (OS) time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM.
Methods: We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects.
Results: An additive scoring system (range: 0-5), based on age, Katz's Activity of Daily Living (ADL) and Lawton's Instrumental Activity of Daily Living (IADL) ≤5 and Charlson Comorbidity Index (CCI) was developed to identify three groups: fit (score = 0); intermediate-fitness (score = 1); and frail (score ≥2). The 3-year OS was 63% in fit patients, 63% in intermediate-fitness patients, and 49% in frail patients ≥3 hematologic adverse events (AEs) were documented in 45 (35.4%) fit, 34 (34%) intermediate-fitness, and 121 (30.2%) frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness (hazard ratios [HR]: 0.99, 95% confidence interval [CI]: 0.54-1.47, P = 1.000) and in frail patients (HR: 1.16, 95% CI: 0.70-1.93, P = 0.558) compared with fit ones.
Conclusions: MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in frailty with International Staging System (ISS) II/III was the worst in all patients.