Multiple myeloma in older patients: Comparing treatment outcomes between fit and frail patients

This study analyzed the results of 3 trials to examine treatment outcomes in frail older patients with multiple myeloma. Authors reported poorer treatment outcomes and a higher rate of side effects among elderly patients in poorer health.

Over 60% of multiple myeloma cases are diagnosed in individuals aged above 65 years. Advances in treatment have increased response and survival rates. However, many older patients are less likely to tolerate new treatments, particularly those patients who are considered frail (of poor physical and mental health). Frail patients are underrepresented in clinical trials. More studies are needed to help understand the role of new treatments in these patients.

The aim of this study was to examine the link between frailty and treatment outcomes, and to create a frailty score.

The results from 3 separate trials were pooled into a single analysis. A total of 869 elderly patients with newly diagnosed multiple myeloma were included. The average age was 74 years. The trials randomly assigned patients to treatment groups. This involved different combinations of chemotherapy drugs with a steroid drug. 2 of the 3 trials also included treatment groups with targeted therapies.

All patients were divided into 1 of 3 health categories based on age, additional medical conditions, and psychological and physical conditions. 39% of patients were considered fit. 31% of patients were of intermediate fitness. 30% of patients were considered frail.

The 3-year overall survival rate (proportion who have not died from any cause since treatment) was 84% among fit patients. This was higher compared to patients with intermediate fitness (76%) and significantly higher compared to frail patients (57%). Disease stage or type of treatment did not affect these results.

At 3 years, 48% of fit patients were progression-free. 41% of patients with intermediate fitness were progression-free. 33% of frail patients were progression-free at 3 years. This was significantly lower than the more fit patients.

The rate of serious blood-related side effects was similar across patient groups. However, the chance of experiencing a serious side effect from treatment (not relating to blood results) was 74% higher among frail patients compared to fit patients. Frail patients were more than twice as likely to stop treatment at 12 months compared to fit patients. The risk of stopping treatment was also 41% higher among patients of intermediate fitness.

Authors concluded that a calculated health status (how frail a patient is) can predict survival and some treatment-related side effects in elderly multiple myeloma patients.

This study only included patients with newly diagnosed multiple myeloma. Results may differ for older patients that have received previous therapies.