Page 27 - Haematologica May 2020

Comprehensive appraisal in cancer patients
We have demonstrated the validity of the R-MCI as a valid prognostic instrument in large MM cohorts treated according to current standards. Based on existing recom- mendations, the R-MCI can be applied in routine clinical care, multicenter analyses and future clinical trials. It may be used in research to compare risk profiles of MM cohorts, to adjust for imbalanced risks, and to provide a basis to establish new clinical or biologic prognostic fac- tors. Moreover, the R-MCI might be considered to be an integral part in the development of individualized risk- adapted treatment strategies to further improve outcome in MM. This includes correct use of resources, higher inclusion rates of older patients into clinical studies, and avoidance of under-supply for older but fit patients.
In the future, the R-MCI could also help to support treatment decisions, tolerability, and to avoid toxicity. Since any prospective comorbidity, frailty and disability evaluation can be time-consuming, we have implemented the R-MCI within a web-based technology application which allows a quick turnaround of results.48 Routine measurement of frailty in MM patients is, therefore feasi- ble, and several analyses via R-MCI11,12 (or IMWG frailty scores18 with various adaptations6,47) are available.
All current developments in the field are enthusiastical- ly welcomed, because more effective and individualized treatment offers an opportunity to further improve clini- cal outcomes, especially among older patients with hematologic malignancies.21,27,28,49 We have proven tools for a functional, more objective assessment to help guide every-day treatment, and these should be incorporated into tumor boards and may allow better trial comparabil- ity, as well as helping to guide trial design. It will be inter- esting to see whether, in the near future, these risk tools are readily implemented into clinical care and can improve patient management. We are entering an excit- ing era for research on aging, which holds unprecedented
promise for increased patient lifespan, delaying patholo- gies of aging, allowing patients to grow old, and living a life full of purpose and well-being (Figure 1).1,50 Future clinical trials that target the aging process and that study biomarkers and intervention programs face considerable challenges, but the potential rewards will far outweigh their risks.1,50
Acknowledgments
The authors thank distinguished IMWG, EMN, DSMM and GMMG experts, especially Drs. Thierry Facon (Lille), Hervé Avet-Loiseau (Toulouse), Alessandra Larocca, Sara Bringhen, Francesca Gay (Turin), Gordon Cook (Leeds), Sonja Zweegman (Amsterdam), Heinz Ludwig (Vienna), Hermann Einsele (Würzburg) and Hartmut Goldschmidt (Heidelberg) for their advice and recommendations. We are also grateful of the insightful comments of all myeloma experts and colleagues at the University Clinic Freiburg (UKF), for their inspiring work and thrive for R- MCI topics. The paper is dedicated to Dr. Sandra Maria Woerner, Maximillian Holler, Sophia Scheubeck, Katja Schoeller, Irina Surlan, Mandy Möller, Stefanie Ajayi, Amelie Rösner, Drs. Martina Kleber, Laura Gengenbach, Giulia Graziani, Maximillian Schinke, Heike Reinhardt, Stefan Müller, Matthias Weiß, Johannes Jung, Christine Greil, Michael Rassner, Cornelius Miething, Milena Pantic and Barbara Deschler (UKF, University of Basel and University of Würzburg) for their exceptional support. We are indebted to the interdisciplinary MM tumorboard, the CCFF for incorporation of the R-MCI in its application modus and thank all MM patients who participated in our MM studies. We also thank the 3 insightful, knowledgeable reviewers for their crit- ical comments, which have further improved this article.
Funding
This work was supported by the Deutsche Krebshilfe (grants 1095969 and 111424 [to ME and RW]) and Verein Senioren- Krebshilfe (R.S.).
Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients. Haematologica. 2017;102(5):910-
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