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Self-Reported Geriatric Impairments and Treatment Toxicity in Older Patients with Multiple Myeloma-A Single Center
Nadine Abdallah1, Rosalyn Marar1, Claire I Yee2
1Mayo Clinic, Rochester, Minnesota, United States.
Abstract:
Frailty influences treatment tolerance and outcomes in older patients with multiple myeloma (MM), yet existing frailty tools capture limited geriatric domains and are incompletely studied in the context of contemporary therapies. We prospectively evaluated patient-reported comprehensive geriatric assessment (CGA) domains, frailty, and their associations with treatment toxicity and patient-reported outcomes(PROs) in older adults with MM.
Methods:
In this single-center prospective study, patients ≥60 years with newly-diagnosed or relapsed/refractory MM initiating a new therapy completed electronic CGA and PRO questionnaires at baseline and 4 months. Outcomes included clinician- and patient-reported treatment toxicity, treatment adaptations, healthcare utilization, and health-related quality of life (HRQOL). A cumulative deficit frailty index (FI) was derived from CGA and HRQOL domains.
Results:
Among 90 patients (mean age:72 years), geriatric impairments were common, particularly physical function domains. High-grade non-hematological toxicities were significantly associated with older age, comorbidities, patient-reported functional limitations, and anxiety. The toxicity rates on PROCTACE were higher than CTCAE, highlighting a discordance between physician-reported and patient-experienced treatment toxicity. Frailty was present in 22% and was associated with worse baseline HRQOL and increased high-grade non-hematological toxicity, but not treatment adaptations or healthcare utilization. Average CGA and HRQOL scores remained stable over 4 months, though individual trajectories varied.
Conclusions:
Patient-reported geriatric impairments are prevalent in older adults with MM and strongly associated with non-hematological toxicities even in the contemporary treatment era. Reliance on physician assessed CTCAE alone fails to fully capture the symptom burden experienced by patients. Changes in geriatric domains during treatment emphasize the need for longitudinal assessment.