@article{001e1f2223084dd2afbabee0597ae4c9,
title = "Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis",
abstract = "The incidence of multiple myeloma is increasing as the proportion of older adults is growing rapidly. A critical evaluation of the evidence available is needed to guide the management of older patients with myeloma. A systematic review was conducted to report the prognostic value of geriatric assessment and frailty scores in older patients with multiple myeloma. We conducted a literature search in February and August 2018. Two researchers extracted the data and assessed the quality of the studies. Geriatric assessment and frailty scores were defined as those evaluating at least 2 geriatric domains. Main outcomes were mortality or toxicity. We estimated the pooled hazard ratios (HR) with 95% confidence intervals (CIs) using a random-effects model. We screened titles and abstracts of 1672 citations for eligibility. Seven studies were included in the qualitative analysis, of which 3 were included in the meta-analysis. Two studies reported similar risks of hematologic adverse events in intermediate-fit and in frail patients compared to frail, but a significantly increased risk of nonhematologic adverse events in frail patients compared to fit patients. In meta-analysis, a significantly increased HR for death was observed in patients with activity of daily living score ≤ 4 (pooled HR = 1.576; 95% CI, 1.051-2.102; χ2 = 0.87; P = .647; I2 = 0). Patients classified as frail showed higher risk of death than fit patients (pooled HR = 2.169; 95% CI, 1.002-2.336; χ2 = 3.02; P = .221; I2 = 33.7%). GA and frailty score are effective in predicting mortality in older adults with myeloma.",
keywords = "Elderly, Frailty models, Multiple myeloma, Older adults, Survival, Toxicity",
author = "Salazar, {A. S.} and Recinos, {Luisa M.} and Mian, {Hira S.} and Carolyn Stoll and Simon, {Laura E.} and Subhjit Sekhon and Colditz, {Graham A.} and Wildes, {Tanya M.}",
note = "Funding Information: Multiple myeloma is a plasma-cell neoplasm that predominantly affects older adults.1 Because the world population is aging rapidly, the proportion of older adults with myeloma is expected to significantly increase in the next decade. Although novel antimyeloma agents have improved outcomes, they can cause severe toxicity, especially in this population. 2-4 Therefore, clinicians face the challenge of determining the optimal treatment for older patients with myeloma, a group that may be vulnerable to toxicities of therapy.5 The American Society of Clinical Oncology recently published guidelines supporting the use of geriatric assessment (GA) to capture the health status and vulnerabilities present in older adults with cancer that could influence treatment tolerance.6 The GA is a multidisciplinary evaluation that provides physicians with information on a patient's overall health, psychosocial status, and functional domains.7 This tool also offers the advantage of revealing underlying aging-associated vulnerabilities and may allow clinicians to anticipate possible complications due to age-related factors.8T.M.W. receives research funding from Janssen and serves as a consultant for Carevive Systems. The other authors have stated that they have no conflict of interest.A.S.S. is supported in part by a training grant from the National Cancer Institute of the National Institutes of Health (award T32CA190194). Funding Information: T.M.W. receives research funding from Janssen and serves as a consultant for Carevive Systems. The other authors have stated that they have no conflict of interest. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",
year = "2019",
month = aug,
doi = "10.1016/j.clml.2019.04.014",
language = "English",
volume = "19",
pages = "488--496.e6",
journal = "Clinical Lymphoma, Myeloma and Leukemia",
issn = "2152-2650",
number = "8",
}