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Letters to the Editor
Table 2. Revised Myeloma Comorbidity Index classification and parameters for the entire cohort of patients, and the Freiburg and multicenter cohorts.
Parameters, mean ± SD Entire cohort (n=284)
R-MCI 0-3 (fit) n=94 (33%)
Age(years) 57±9.3
Freiburg cohort (n=232)
n=62 (27%)
57±8.8 86±8.4
76 ± 24.0
41 ± 26.0 1±0.7 1±1.1 0±0.5 5±0.9 8±0.6 3±0.8 10±3.0 n=141 (61%) 62 ± 10.5
73 ± 13.5
65 ± 27.2
43 ± 29.0 1±1.0 2±1.2 1±1.1 5±1.1 7±1.7 4±1.1 12±6.0 n=29 (12%) 73±5.9
59 ± 10.3
42 ± 26.7
45 ± 19.9 2±1.0 3±1.4 2±0.8 4±1.3 6±2.1 4±0.9 19±8.3
Multicenter cohort (n=52)
n=32 (62%)
56±10.2 92±7.4
84 ± 21.4 48 ± 27.6 1±0.6 2±2.1 0±0.3 6±0.0 8±0.0 2±0.6 8±1.0 n=18 (34%) 67±8.4 81±7.3
56 ± 29.5 44 ± 31.9 1±0.8 4±2.0 1±0.9 6±0.5 8±1.2 3±0.8 10±2.7 n=2 (4%) 67±9.9 65±7.1 53±4.3
50 ± 42.4 2±0.7 2±1.4 3±0.7 6±0.0 4±0.7 5±0.7 46±48.1
Karnofsky Performance Status (%) Renal function: eGFR (mL/min/1.73 m2) Bone marrow plasma cells (%) IMWG-frailty score (scale 0-5) CCI(scale0-37)
Frailty(scale0-3)
ADL(scale0-6)
IADL(scale0-8)
Fitness(scale1-6)
TUGT(s)
R-MCI 4-6 (intermediate fit)
Age (years)
Karnofsky Performance Status (%)
Renal function: eGFR (mL/min/1.73 m2)
Bone marrow plasma cells (%)
IMWG-frailty score (scale 0-5)
CCI(scale0-37)
Frailty(scale0-3)
ADL(scale0-6)
IADL(scale0-8)
Fitness(scale1-6)
TUGT(s) 12±5.7
R-MCI 7-9 (frail) n=31 (11%)
Age(years) 73±6.1
Karnofsky Performance Status (%)
Renal function: eGFR (mL/min/1.73 m2)
Bone marrow plasma cells (%)
IMWG-frailty score (scale 0-5)
CCI(scale0-37)
Frailty(scale0-3)
ADL(scale0-6)
IADL(scale0-8)
Fitness(scale1-6)
TUGT(s) 21±13.7
88 ± 8.6
79 ± 23.3
44 ± 26.6 1±0.7 2±1.6 0±0.5 5±0.9 8±0.5 3±0.8 9±2.6 n=159 (56%) 63 ± 10.4
73 ± 13.2 64 ± 27.5 43 ± 29.2 1±1.1 2±1.4 1±1.1 5±1.1 7±1.7 3±1.1
60 ± 10.2 42 ± 25.9 46 ± 20.9 2±1.0 3±1.4 2±0.8 5±1.3 6±2.1 5±0.9
R-MCI: Revised Myeloma Comorbidity Index; n: number; KPS: Karnofsky Performance Status; eGFR: estimated glomerular filtration rate; PC: plasma cells; CCI: Charlson Comorbidity Index; IMWG: International Myeloma Working Group; ADL: Activities of Daily Life; IADL: Instrumental Activities of Daily Life; TUGT: timed up and go test; SD: standard deviation; s: seconds.
formed in 284 consecutive MM patients at the time of initial diagnosis or first presentation at five DSMM/EMN centers between July 2015 and March 2016. The cohort was assessed as a whole and in a subgroup analysis, in which the UKF cohort (n=232) was compared to the mul- ticenter cohort (UW, UU, UJ, UL; n=52). Age, gender, dis- ease characteristics, R-MCI, IMWG-frailty score, CCI and functional geriatric tests were assessed. Frailty, deter- mined via: (i) KPS <70%; (ii) physician-rated fitness grade 5 or 6 (=dismal); (iii) timed-up-and-go-test (TUGT) >10 seconds; and/or (iv) instrumental activities of daily living (IADL) ≤4, as described elsewhere,12,13,17 was scored as no/mild with 0/1, moderate with 2, or severe with >2 of parameters (i) – (iv) (Table 1). Due to logistics, allowing a
time-restricted assessment in the external EMN/DSMM centers (UW, UU, UJ, UL: 1 week each), the multicenter cohort reflected primarily outpatients and the UKF cohort both in- and outpatients. The assessment was consistently performed by the same person (SMD).6,12,13 Detailed methods and the definition of risk scores are described in Online Supplementary Tables S1 and S2.
The patients’ characteristics of the entire cohort (n=284) and both the UKF (n=232) and multicenter (n=52) cohorts were typical for tertiary centers and fairly similar. Advanced MM stages, according to the Durie & Salmon staging system and the ISS, and renal function (assessed by the estimated glomerular filtration rate) were somewhat more favorable in the multicenter cohort
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