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Multiple myeloma, gammopathies

External validation of the FIRST trial’s simplified frailty score in a population-based cohort

Leukemia volume 35, pages 1823–1827 (2021)Cite this article

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Multiple myeloma is a disease of older adults, with a median age of 70 at diagnosis. Better risk stratification strategies are required to identify older, fit adults who benefit from more aggressive treatment for maximal disease control, while simultaneously identifying frail patients in whom treatment modification may be required in order to improve tolerability and reduce toxicity. To assess the fitness of this heterogenous group of older adults with newly-diagnosed multiple myeloma (NDMM), many groups have proposed frailty tools which predict patient outcomes [1,2,3]. However, many of these tools are perceived to be time consuming or require specialized investigations limiting the uptake of these scores [4]. Facon et al. recently derived a ‘simplified frailty scale’ based upon age, Charlson Co-Morbidity Index and Eastern Cooperative Group Oncology Group performance status (ECOG-PS), using a single clinical trial dataset from the phase 3 FIRST trial [5]. Following a simple additive score, patients were dichotomized as being frail or non-frail, with the former experiencing worse overall survival, progression-free survival and treatment emergent adverse events. This was also validated in an additional transplant ineligible clinical trial dataset [6]; however, given that many older patients with NDMM in the real-world continue to be under-enrolled in clinical trials [7], there is a need to validate this score in a real-world population-based cohort.

In this study, we aimed to externally validate Facon et al. simplified frailty scale in a non-trial population cohort of transplant ineligible NDMM patients receiving treatment in Ontario, Canada between the years 2007 and 2018. We classified patients into frail or non-frail subgroups based upon the simplified frailty scale and examined the following outcomes: early mortality (<1 year), health care utilization (within the first year) and overall survival (OS).

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Acknowledgements

HM is supported in part by the HHS Research Early Career Award from Hamilton Health Sciences Foundation. This investigation was supported by funding from Myeloma Canada. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed in the material are those of the authors, and not necessarily those of CIHI. We acknowledge Cancer Care Ontario for access to the Ontario Cancer Registry (OCR), Cancer Activity Level Reporting (ALR), Symptom Management Database (ESAS) and The New Drug Funding Program (NDFP). We thank IQVIA Solutions Canada Inc. for use of their Drug Information Database. SG is supported in part by the Walter B Frommeyer Fellowship in Investigative Medicine, Department of Medicine, University of Alabama at Birmingham

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Authors and Affiliations

  1. Juravinski Cancer Center, Department of Oncology, McMaster University, Hamilton, ON, Canada

    Hira S. Mian, Amaris K. Balitsky, Gregory R. Pond & Hsien Seow

  2. Institute for Cancer Outcomes and Survivorship, Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA

    Smith Giri

  3. Cancer & Aging Research Group, St. Louis, MO, USA

    Tanya M. Wildes

  4. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Arleigh McCurdy

  5. McMaster University, Hamilton, ON, Canada

    Branavan Sivapathasundaram

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  1. Hira S. Mian
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Correspondence to Hira S. Mian.

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Conflict of interest

HS: Consultancy/Honoraria fees from Celgene, Takeda, Janssen, Amgen, Sanofi, SG: Reports research funding from CareVive, PackHealth, Sanofi and Oncopeptides. Honoraria from Carevive, Janssen, GP: Has a close family member who is employed by Roche Canada, and who owns Roche Canada stock. Consultancy fees from Astra-Zeneca. Honorarium from Takeda, TW: reports Research funding from Janssen and is a consultant for Carevive Systems and Seattle Genetics, AB, BS, AM, HS: None.

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Mian, H.S., Giri, S., Wildes, T.M. et al. External validation of the FIRST trial’s simplified frailty score in a population-based cohort. Leukemia 35, 1823–1827 (2021). https://doi.org/10.1038/s41375-021-01247-9

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