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Multiple myeloma gammopathies

Validation of the FIRST simplified frailty scale using the ECOG performance status instead of patient-reported activities

Leukemia volume 34, pages 1964–1966 (2020)Cite this article

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The International Myeloma Working Group (IMWG) developed a frailty index based on age, comorbidities, and the capacity to perform (instrumental) activities of daily living reported by patients [1]. Recently, Facon et al. performed an important effort to adjust this model with data from the FIRST trial using the physician-reported ECOG performance score instead of patient-reported performance [2]. This simplified ‘frailty scale’ will allow comparisons between studies, which is highly useful given the biological heterogeneity of elderly myeloma patients.

The authors acknowledge that their results should be validated in an independent dataset. We therefore assessed their model in our dataset of the HOVON87/NMSG18 study, including 636 elderly non-transplant eligible newly diagnosed myeloma patients. In this randomized trial, nine cycles of melphalan, prednisone, thalidomide followed by maintenance therapy with thalidomide (MPT-T) was compared with melphalan, prednisone, lenalidomide followed by maintenance therapy with lenalidomide (MPR-R). Efficacy was comparable, however the toxicity profile was different, with more pronounced neurotoxicity and hematological toxicity in the thalidomide- and lenalidomide-treated patients, respectively [3].

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References

  1. Palumbo A, Bringhen S, Mateos MV, Larocca A, Facon T, Kumar SK, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood 2015;125:2068–74.

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  2. Facon T, Dimopoulos MA, Meuleman N, Belch A, Mohty M, Chen WM, et al. A simplified frailty scale predicts outcomes in transplant-ineligible patients with newly diagnosed multiple myeloma treated in the FIRST (MM-020) trial. Leukemia 2019;34:224–33.

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  3. Zweegman S, van der Holt B, Mellqvist UH, Salomo M, Bos GM, Levin MD, et al. Melphalan, prednisone, and lenalidomide versus melphalan, prednisone, and thalidomide in untreated multiple myeloma. Blood 2016;127:1109–16.

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Author notes

  1. These authors contributed equally: Claudia A. M. Stege and Bronno van der Holt

Authors and Affiliations

  1. Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Claudia A. M. Stege, Avinash G. Dinmohamed, Niels W. C. J van de Donk & Sonja Zweegman

  2. Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Bronno van der Holt

  3. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Avinash G. Dinmohamed

  4. Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

    Avinash G. Dinmohamed

  5. Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Pieter Sonneveld

  6. Department of Internal Medicin, Albert Schweitzer Hospital, Dordrecht, The Netherlands

    Mark-David Levin

  7. Department of Hematology, South Elvsborg Hospital, Borås, Sweden

    Ulf-Henrik Mellqvist

  8. Department of Hematology, St Olavs Hospital/Norwegian University of Science and Technology, Trondheim, Norway

    Anders Waage

Authors
  1. Claudia A. M. Stege
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  2. Bronno van der Holt
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  3. Avinash G. Dinmohamed
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  4. Pieter Sonneveld
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  5. Mark-David Levin
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  6. Niels W. C. J van de Donk
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  7. Ulf-Henrik Mellqvist
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  8. Anders Waage
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  9. Sonja Zweegman
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Corresponding author

Correspondence to Sonja Zweegman.

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Conflict of interest

CAMS, BvdH, AGD, M-DL, U-HM, and AW have no competing financial interests. SZ received research funding from Celgene, Takeda, and Janssen and participated in advisory boards from Celgene, Takeda, Janssen, and Sanofi. NWCJvdD received research funding from Celgene, BMS, and Janssen and participated in advisory boards from Celgene, Takeda, Janssen, Sanofi, and BMS. PS received research funding from Celgene, Janssen, and Amgen and participated in advisory boards from Celgene, Janssen, and Amgen. The HOVON87/NMSG18 study was partly funded by Celgene.

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Stege, C.A.M., van der Holt, B., Dinmohamed, A.G. et al. Validation of the FIRST simplified frailty scale using the ECOG performance status instead of patient-reported activities. Leukemia 34, 1964–1966 (2020). https://doi.org/10.1038/s41375-020-0713-4

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