Related Experiment Video
Updated: Apr 14, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Prognostic effect of comorbidity indices in elderly patients with multiple myeloma
Jelena Bila1, Jelena Jelicic1, Vladislava Djurasinovic2
1Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Insights
Comorbidity and daily living abilities significantly impact multiple myeloma outcomes in elderly patients. The Charlson Comorbidity Index (CCI) and Instrumental Activities of Daily Living (IADL) scale help predict survival and personalize treatment.
Area of Science:
- Geriatric Medicine
- Hematology
- Oncology
Background:
- Elderly multiple myeloma (MM) patient care requires assessing comorbidity, disability, and frailty.
- The Charlson Comorbidity Index (CCI) and Instrumental Activities of Daily Living (IADL) scale are crucial for treatment decisions.
Purpose of the Study:
- To analyze the prognostic impact of the CCI and IADL on the disease course of elderly MM patients.
- To evaluate the correlation between comorbidity indices and daily functioning with survival outcomes.
Main Methods:
- Study included 110 newly diagnosed MM patients over 65 years old.
- Patients were assessed using CCI, age-adjusted CCI (aaCCI), and IADL.
- Treatment regimens included thalidomide- and bortezomib-based combinations or conventional chemotherapy.
Main Results:
- High CCI/aaCCI scores correlated with advanced International Staging System (ISS) score 3 and lower IADL scores.
- Increased CCI (≥2), aaCCI (≥5), and decreased IADL (<3) were associated with higher probabilities of adverse events.
- Patients with CCI 0-1 had longer overall survival (OS), while those with aaCCI ≥5 or IADL >3 showed significantly different OS.
Conclusions:
- CCI, aaCCI, and IADL are significant prognostic clinical parameters in elderly MM.
- A personalized treatment model incorporating aaCCI (≥5) and IADL (>3) scores is proposed for improved patient management.
Background:
Consideration of comorbidity, disability, and frailty represents a significant part of the treatment of elderly multiple myeloma (MM) patients. The aim of study was to analyze the effect of the Charlson Comorbidity Index (CCI) and scale of Instrumental Activities of Daily Living (IADL) on the course of disease.
Patients And Methods:
The study included 110 newly diagnosed MM patients older than 65 years of age. According to the CCI most patients had at least 1 comorbidity (CCI score of 1) and most of them (51 of 110 patients; 46.4%) had an age-adjusted CCI (aaCCI) score of 5 to 6. Most of our patients were capable of performing routine daily activities (IADL ≥ 6). Patients were treated with thalidomide- and bortezomib- based combinations, or with conventional chemotherapy.
Results:
International Staging System (ISS) score 3 correlated with high scores of CCI or aaCCI (R = 0.314, P < .003; R = .317, P < .002, respectively), and lower IADL (R = 0.259, P < .007). The probability of adverse events was 70% greater for CCI score ≥ 2 (odds ratio [OR], 1.72); 28% for aaCCI ≥ 5 (OR, 1.28) and 22% higher for IADL < 3 (OR, 2.25). The patients with a CCI score of 0 to 1 had significantly longer overall survival (OS; log rank, 6.538; P < .011). The patients with aaCCI ≥ 5 had significantly shorter OS (log rank, 4.209; P < .040), and the patients with IADL > 3 had significantly longer OS (log rank, 6.62; P < .001). In the proposed model, aaCCI ≥ 5 and IADL > 3 scores had a major effect on the OS (χ(2), 8.46; P = .037).
Conclusion:
CCI, aaCCI, and IADL scale are clinical parameters of prognostic significance. A proposed model for a personalized treatment approach is based on variables such as scores for aaCCI ≥ 5 and IADL > 3.
Related Concept Videos
01:21Cancer Survival Analysis
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism