Page 229 - 2021_03-Haematologica-web

Letters to the Editor
Validation of the Revised Myeloma Comorbidity Index and other comorbidity scores in a multicenter German study group multiple myeloma trial
In the past decade, the survival of patients with multi- ple myeloma (MM) has improved significantly. This encouraging progress has been driven by deeper biologi- cal insights, implementation of more sensitive diagnostic tests leading to earlier diagnosis, access to more effective therapies and better supportive care.1 MM typically affects elderly patients, who are less likely to endure treatment and who have a less favorable long-term prog- nosis.2 Moreover, accompanying diseases may compli- cate anti-myeloma treatment.1 In general, comorbidities have been shown to influence cancer patients' general health status, limit their physical condition, and worsen their progression-free and overall survival.3,4 Therefore, with the growing number of elderly (and frail) MM patients, reliable tools to assess patients' vulnerability, as expressed by chronic conditions and limitations in daily activities, are wanted to guide us through today’s multi- ple possible therapeutic options.5,6
Historically, treatment decisions for symptomatic MM
patients were age-based. Ideally nowadays disease biolo- gy and fitness, including patients' Karnofsky Performance Status (KPS) or Eastern Cooperative Oncology Group Performance Status (ECOG-PS), are considered when assessing therapeutic options.5 However, KPS and ECOG-PS are often overestimated and may not reflect patients’ entire functional status.4,6 We and others have learnt from re-scoring cancer patients that initially esti- mated KPS and ECOG-PS scores, measured by physicians and health staff, are often claimed to be much better than those determined by objective definition and the patients’ actual fitness status. In a prior analysis, we re- scored the KPS in approximately 500 MM patients who had appeared, according to the physicians' initial esti- mate, almost uncompromised with a median score of 90%, but on re-scoring had scores 30% lower than ini- tially presumed.4,6 More objective parameters to assess patients' PS and fitness are therefore warranted. Moreover, since elderly MM patients are often excluded from clinical trials due to strict inclusion criteria,7 trial results typically reflect <10% of 'real-world patients' and are less well transferable to elderly patients.8,9
In this context, the International Myeloma Working Group (IMWG), European Myeloma Network (EMN) and
AD
BE
CF
Figure 1. Distribution of fitness status according to the different comorbidity scores in the different cohorts. (A) According to the Revised Myeloma Comorbidity Score (R-MCI), 33% of the entire cohort (n=284) were fit, 56% were intermediate-fit and 11% were frail. (B) According to the Charlson Comorbidity Index (CCI), 41% of the entire cohort (n=284) were fit, 51% were intermediate-fit and 8% were frail. (C) According to the International Myeloma Working Group (IMWG) frailty score, 27% of the entire cohort (n=284) were fit, 38% were intermediate-fit and 35% were frail. (D) According to the R-MCI, 27% of the Freiburg cohort were fit, 61% were intermediate-fit and 12% were frail. The corresponding percentages for the multicenter cohort were 62%, 34% and 4%. (E) According to the CCI, 43% of the Freiburg cohort were fit, 53% were intermediate-fit and 4% were frail. The corresponding percentages for the multicenter cohort were 33%, 44% and 23%. (F) The IMWG frailty score determined that 26% of the Freiburg cohort were fit, 33% were intermediate-fit and 41% were frail. The corresponding percentages for the multicenter cohort were 31%, 60% and 9%.
haematologica | 2021; 106(3)
875