Geriatric Assessment Recommended in All Elderly Multiple Myeloma Patients

Clinical judgment of frailty alone underestimates the geriatric risk profile in newly diagnosed elderly patients with multiple myeloma (MM), according to a study presented at the 2021 International Myeloma Workshop.

According to the study abstract, “several geriatric risk scores have been developed … however, comprehensive geriatric assessment is not widely adopted in daily practice.” Instead, many clinicians rely on their clinical skills to judge if a patient is fit.

The Compass trial is a prospective study of newly diagnosed patients with MM aged 70 years or older that compared frailty measurements by clinical assessment (CA) and geriatric screening (GA) at diagnosis and after three months. The initial GA was performed using the G8 score. If the G8 score was higher, additional screening was performed.

At enrollment 74% of patients were aged 75 years or older. According to CA, 43% of patients were scored as frail, compared with 69% using the G8. Compared with patients deemed to be fit by both CA and GA (fit-fit), patients who were fit by CA but frail by GA (fit-frail) were older (P = 0.002), had reduced nutritional status (P<0.001) and more recent weight loss (P<0.001), received more polypharmacy (P<0.001), and considered their own health status as poorer (P<0.001).

Among those that were fit-frail, 23% of physicians modified the upfront treatment regimen based on the G8 compared with only 8% in the fit-fit group. Additionally, 45% of patients who were fit-frail required dose reductions compared with only 33% of patients who were fit-fit.

After three months of treatment, the majority of patients remained in the same frailty categories. This reinforced that a patient’s frailty status at diagnosis is not driven by myeloma-related symptoms, according to the researchers.

“Based on our study results, minimal geriatric screening tools like G8 are recommended in all elderly MM patients before treatment initiation,” the researchers concluded.

These data are from Abstract P-162 “Compass: A prospective study comparing clinical evaluation with different geriatric screening methods in newly diagnosed elderly multiple myeloma patients,” presented at IMW 2021, September 8-11, 2021.