Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

The Real-World Evidence on the Fragility and Its Impact on the Choice of Treatment Regimen in Newly Diagnosed Patients With Multiple Myeloma Over 75 Years of Age

Agata Tyczyńska
,
Marcela Krzysława Krzemek
ORCID logo ,
Alexander Jorge Cortez
ORCID logo ,
Artur Jurczyszyn
ORCID logo ,
Katarzyna Godlewska
,
Hanna Ciepłuch
,
Edyta Subocz
,
Janusz Hałka
,
Anna Kulikowska de Nałęcz
,
Anna Wiśniewska
,
Alina Swiderska
,
Anna Waszczuk-Gajda
,
Joanna Drozd-Sokołowska
ORCID logo ,
Renata Guzicka-Kazimierczak
,
Agnieszka Porowska
,
Kamil Wiśniewski
,
Wanda Knopińska-Posłuszny
,
Janusz Kłoczko
,
Piotr Rzepecki
,
Dariusz Woszczyk
,
Hanna Symonowicz
,
Grzegorz Władysław Basak
ORCID logo ,
Barbara Zdziarska
,
Krzysztof Jamroziak
,
Jan M. Zaucha
*
Version 1 : Received: 30 May 2023 / Approved: 30 May 2023 / Online: 30 May 2023 (12:26:24 CEST)

A peer-reviewed article of this Preprint also exists.

Tyczyńska, A.; Krzempek, M.K.; Cortez, A.J.; Jurczyszyn, A.; Godlewska, K.; Ciepłuch, H.; Subocz, E.; Hałka, J.; Kulikowska de Nałęcz, A.; Wiśniewska, A.; Świderska, A.; Waszczuk-Gajda, A.; Drozd-Sokołowska, J.; Guzicka-Kazimierczak, R.; Wiśniewski, K.; Porowska, A.; Knopińska-Posłuszny, W.; Kłoczko, J.; Rzepecki, P.; Woszczyk, D.; Symonowicz, H.; Basak, G.W.; Zdziarska, B.; Jamroziak, K.; Zaucha, J.M. The Real-World Evidence on the Fragility and Its Impact on the Choice of Treatment Regimen in Newly Diagnosed Patients with Multiple Myeloma over 75 Years of Age. Cancers 2023, 15, 3469. Tyczyńska, A.; Krzempek, M.K.; Cortez, A.J.; Jurczyszyn, A.; Godlewska, K.; Ciepłuch, H.; Subocz, E.; Hałka, J.; Kulikowska de Nałęcz, A.; Wiśniewska, A.; Świderska, A.; Waszczuk-Gajda, A.; Drozd-Sokołowska, J.; Guzicka-Kazimierczak, R.; Wiśniewski, K.; Porowska, A.; Knopińska-Posłuszny, W.; Kłoczko, J.; Rzepecki, P.; Woszczyk, D.; Symonowicz, H.; Basak, G.W.; Zdziarska, B.; Jamroziak, K.; Zaucha, J.M. The Real-World Evidence on the Fragility and Its Impact on the Choice of Treatment Regimen in Newly Diagnosed Patients with Multiple Myeloma over 75 Years of Age. Cancers 2023, 15, 3469.

Abstract

Fragility scales are intended to help in therapeutic decisions. Here we asked if the fragility as-sessment in MM patients ≥75 years old qualified for treatment by the local physician correlates with the choice of treatment: a 2- or 3-drug regimen. Between 7/2018 to 12/2019 we prospectively enrolled 197 MM patients at the start of treatment from the 13 Polish Myeloma Group centers. The data to assess fragility were prospectively collected, but centrally assessed fragility was not disclosed to the local center. The activity of daily living (ADL) could be assessed in 192 (97.5%) and was independent in 158 (80.2%), moderately impaired in 23 (11.7%), and 11 (5.6%) in com-pletely dependent. Patients with more than 3 comorbidities were 26.9% (53 patients). Thus, ac-cording to the Palumbo calculator, 43 patients were in the intermediate-fitness group (21.8%), and the rest belonged to the frailty group (153, 77.7%). Overall, 79.7% of patients (157) received 3-drug regimens and 20.3% (40) received 2-drug regimens. In each ECOG group, more than 3/4 of patients received 3-drug regimens. According to the ADL scale, 82.3% of the independent 65.2% of moderately impaired, and 81.8% of the dependent received 3-drug regimens. Out of 53 pa-tients with at least 4 comorbidities, 71.7% received 3-drug regimens, and the rest 2-drug regi-mens. Three-drugs regimens received 34 patients from the intermediate-fit group (79.0%), and 123 (79.9%) from the frail group. Early mortality occurred in 25 patients (12.7%). No one discon-tinued treatment due to toxicity. To conclude, MM patients over 75 are mainly treated with tri-ple-drug regimens, not only in reduced doses, regardless of their frailty scores. However, the absence of prospective fragility assessment did not negatively affect early mortality and the number of treatment discontinuations which questions the clinical utility of current fragility scales in everyday practice.

Keywords

frailty; elderly; multiple myeloma; choice of treatment; over 75 years old; early mortality

Subject

Medicine and Pharmacology, Hematology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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