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Letters to the Editor
Table 1. Baseline characteristics of the entire cohort of patients and of the Freiburg versus multicenter cohorts.
Variables
Patients’ characteristics
Age at initial diagnosis, years Gender, male /female
KPS, %
Disease characteristics
%
59 / 41
Mean (range)
62 (27-85) 80 (30-100)
%
62 / 38
Mean (range)
60 (32-84) 90 (60-100)
%
42 / 58
ISS, I/II/III
PC histology, %
PC cytology, % Cytogenetics (FISH)
favorable unfavorablea missing
Estimated GFR, mL/min/1.73 m2
Comorbidity scores and frailty
R-MCI (scale 0-9) IMWG-frailty score (scale 0-5) CCI (scale 0-33)
Frailtyb
43 (0-100) 42 (0-100)
67 (7-163)
4 (0-9) 1 (0-3) 2 (0-8)
37/29/34
39 41 20
43 (0-100) 40 (0-90)
65 (7-163)
4 (0-9) 1 (0-3) 2 (0-7)
34/28/38
44 41 20
47 (5-100) 46 (5-100)
73 (8-130)
3 (0-7) 1 (0-3) 3 (0-8)
50/33/17
37 46 17
All (n=284)
Mean (range)
62 (27-85) 80 (30-100)
Freiburg cohort (UKF; n=232)
Multicenter cohort (UW, UU, UJ, UL; n=52)
Durie & Salmon
I/II/III 18/12/70 17/10/73 23/19/58 A/B 80/20 78/22 92/8
no/mild 51/21 46/21 73/19
moderate
severe
Fitness assessments
ADL (scale 0-6)
IADL (scale 0-8)
Physician-rated fitnessc (scale 1-6)
TUGTd (s)
12 16
14 19
2 6
5 (2-6) 7 (1-8) 3 (1-6) 12 (4-80)
5 (2-6) 7 (1-8) 3 (1-6) 12 (4-32)
6 (4-6) 8 (3-8) 2 (1-5) 10 (6-80)
aunfavorable cytogenetics (FISH) defined as t(4;14) or t(14;16) or del17p13 or chr.1 aberrations. bFrailty (adapted according to Fried) defined as Karnofsky Performance Status ≤70%; physician-rated fitness as: 5 or 6; : timed up and go test >10 sec; instrumental activities of daily living ≤4; no = no parameters compromised; mild = 1 parameter compromised; moderate = 2 parameters compromised; severe >2 parameters compromised (http://www.myelomacomorbidityindex.org/en_calc.html). cPhysician-rated fit- ness (1-6): 1 represents best fitness and 6 represents worst fitness status. dTimed up and go test in seconds (s): <10 s = fit, 10-20 s: moderate-fit, >20 s unfit/frail. UKF: University of Freiburg; UW: University of Würzburg; UU: University of Ulm; UJ: University of Jena; UL: University of Leipzig; ISS: International Staging System; FISH: fluorescence in situ hybridization; KPS: Karnofsky Performance Status; PC: plasma cell; GFR: glomerular filtration rate; R-MCI: Revised Myeloma Comorbidity Index; IMWG: International Myeloma Working Group; CCI: Charlson Comorbidity Index; IADL: instrumental activities of daily living; ADL: activities of daily living; TUGT: timed up and go test.
others (Deutsche Studiengruppe Multiples Myelom [DSMM], German-Speaking Myeloma Multicenter Group [GMMG], Intergroupe Francophone du Myélome [IFM], Hemato-Oncology Foundation for Adults in the Netherlands [HOVON], Scandinavian and UK study groups) recommended that physical condition and comorbidities should be included in therapy deci- sions.5,10,11 Risk scores for MM have included disease- related risks (scores of the International Staging System and its Revision [ISS/R-ISS], lactate dehydrogenase con- centration, cytogenetics and, recently, comorbidity screening tests (Revised Myeloma Comorbidity Index [R- MCI], IMWG-frailty score and others).5,11–13 Prior test14 and repeated independent validation analyses4,15 estab- lished the IMWG-frailty score and R-MCI in MM,6,11-13 and enable the objective designation of fit, intermediate- fit and frail groups of patients with substantially different progression-free and overall survival rates. The intention of this multicenter analysis was the prospective valida-
tion of the R-MCI and comorbidity scores in five EMN/DSMM study sites (Universities of Freiburg [UKF], Würzburg [UW], Ulm [UU], Jena [UJ], and Leipzig [UL]). The external centers we chose for this multicenter analy- sis had to be: (i) equally large as ours (i.e., UKF); (ii) treat similar numbers of MM patients; and (iii) use identical DSMM study protocols. Of the centers we visited, the UW, UU, UJ and UL met these criteria. The aims of the study were to assess possible differences in: (i) patient and disease characteristics; (ii) comorbidity scores (R- MCI, IMWG-frailty score, Charlson Comorbidity Index [CCI]); and (iii) simple, functional fitness tests (Tables 1 and 2). The evaluation of whether comorbidity scores and a brief selection of fitness tests allow more precise detection of group variations in different centers, rather than that determined via patients’ characteristics such as age and stage alone, was performed because previously postulated as highly relevant.11,16
This prospective, multicenter assessment was per-
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haematologica | 2021; 106(3)