Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores

Abstract

This first validation of the International Myeloma Working Group geriatric assessment in 125 newly diagnosed multiple myeloma patients was performed using the International Myeloma Working Group score based on age, Charlson Comorbidity Index and cognitive and physical conditions (Activity of Daily Living / Instrumental Activity of Daily Living) to classify patients as fit, intermediate-fit or frail. We verified the International Myeloma Working Group score's impact on outcome and whether additional tools complement it. Since our prior analyses determined renal-, lung- and Karnofsky performance impairment as multivariate risks, and inclusion of frailty, age and cytogenetics complements this, we included the revised-Myeloma Comorbidity Index, Charlson Comorbidity Index, Hematopoietic-Cell-Transplantation Comorbidity Index and Kaplan Feinstein in this assessment. Multivariate analysis confirmed cytogenetics, Activity of Daily Living, Instrumental Activity of Daily Living and Charlson Comorbidity Index as risks: 3-year-overall survival for fit, intermediate-fit and frail patients was 91%, 77% and 47%, respectively. Using the Charlson Comorbidity Index, Hematopoietic-Cell-Transplantation Comorbidity Index, Kaplan Feinstein and revised-Myeloma Comorbidity Index allowed to define fit and frail patients with distinct progression free and overall survival, with most pronounced differences via International Myeloma Working Group score, Charlson Comorbidity Index and revised-Myeloma Comorbidity Index. Since the Charlson Comorbidity Index is included in the International Myeloma Working Group score, we propose the latter and revised-Myeloma Comorbidity Index for future frailty measurements. Both are useful instruments for identifying myeloma patients with a geriatric risk profile and have strong prognostic value for functional decline and overall survival. The study was registered at DRKS-00003686.