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Multiple myeloma gammopathies

Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network

Leukemia volume 34, pages 2285–2294 (2020)Cite this article

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Abstract

As the treatment landscape continues to evolve towards the application of precision medicine in multiple myeloma (MM), there is a clear need to identify those patients who are at risk of not achieving the maximum benefit whilst exposed to the highest level of toxicity. This group of patients, defined as frail, is an unmet clinical need. However, how we define such a vulnerable group of patients with MM remains to be clarified. An integral aspect of this is to define the physiological age and capacity of patients with MM to deal with the burden of their disease and it’s treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. A need to develop, test and validate clinical screening scores before their adoption into clinical practice is mandated. This position paper from the European Myeloma Network aims to review what is known about defining frailty in MM, and how we can advance this knowledge for the design of clinical trials and ultimately how we deliver treatment in the clinic.

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Fig. 1: Defining frailty in suscetible populations.
Fig. 2: The Frailty Spiral. The impact of aging, cellualr senescence and comorbidities on the evolution of frailty wiht the myeloma clinical features acting as “accelerants”.

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Authors and Affiliations

  1. Leeds Institute of Clinical Trial Research & Leeds Cancer Centre, University of Leeds, Leeds, UK

    Gordon Cook

  2. Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy

    Alessandra Larocca

  3. CHU Lille, Service des Maladies du Sang, F-59000, Lille, France

    Thierry Facon

  4. Department of Haematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Sonja Zweegman

  5. Medical Department, Hematology, Oncology & Stem Cell Transplantation, Clinical Cancer Research Group, Freiburg, Faculty of Freiburg, Freiburg, Germany

    Monika Engelhardt

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GC, AL, SZ, TF and ME designed the manuscript content and GC wrote the first draft. GC, AL, SZ, TF and ME edited and produced the final draft for submission.

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GC—Honoraria: Amgen, Bristol-Myers Squibb, Celgene, Janssen, Sanofi, Karyopharm and GSK; Research funding: Celgene, Janssen, Takeda. AL—Honoraria: Amgen, Bristol-Myers Squibb, Celgene, Janssen and GSK; Advisory Board: Bristol-Myers Squibb, Celgene, Janssen, Takeda. SZ—Advisory board: Celgene, Janssen, Takeda, Sanofi, Oncopeptides; Research support: Celgene, Janssen, Takeda. TF and ME—no relevant conflicts.

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Cook, G., Larocca, A., Facon, T. et al. Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network. Leukemia 34, 2285–2294 (2020). https://doi.org/10.1038/s41375-020-0918-6

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