S90 EXABS-201-MM Treatment of the Frail Multiple Myeloma Patient: Personalized Care Elizabeth O’Donnell, MD1,* 1Dana-Farber Cancer Institute, Boston, USA *Corresponding author: elizabeth_odonnell@dfci.harvard.edu Keywords Multiple myeloma, frail Introduction Multiple myeloma (MM) is currently an incurable hematologic malignancy. It represents 10 percent of all hematologic malignancies with an estimated 34,470 cases in 2022.1 Despite the varied biology, MM predominantly affects a relatively narrow age range with the majority of patients diagnosed between 65 to 74 years, with a median age at onset of 69 years.2 A third of patients are ≥75 years at the time of diagnosis, making MM a disease of aging. While this disease can impact individuals of all ages, frail adults face unique challenges when it comes to managing MM. Frailty, characterized by diminished strength and reduced physiological reserve,3 can complicate the diagnosis, treatment, and overall care of these individuals. In this abstract, we will explore the specific issues faced by frail adults with MM and discuss the importance of tailored care strategies to improve their care and quality of life. Assessing Frailty In considering the approach to the frail patient, it is important to understand the distinctive aspects of frailty and how they interact with MM. Frailty is not a disease itself, but rather a state of vulnerability associated with aging and chronic illness.3 Frail individuals often experience a decline in physical function, such as muscle weakness, decreased mobility, and fatigue. These factors can have a significant impact on the ability to tolerate cancer treatments. Several comorbidity indexes have been developed such as the Charlson Comorbidity Index (CCI), the Kaplan-Feinstein Index, and the Hematopoietic Cell Transplantation-Comorbidity Index, with the former developed over 3 decades ago.4,5 These are broadly used and predict one-year mortality based on comorbid conditions. However, none were specifically designed for MM. The Myeloma Comorbidity Index (MCI) and later a revised version (R-MCI), were developed in recent years using a weighted risk factor assessment including renal and lung function, frailty, and age, with the option to add cytogenetics.6 In clinical practice a widely accepted tool is the IMWG frailty scoring system combining age, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and CCI, and identifies 3 groups: fit, intermediate, and frail. Initially designed for use in clinical trials, IMWG frailty score has been externally validated and is an accepted standard in many practices6. Frailty scores can be used to guide upfront dose modifications of therapies for patients with the goal of mitigating side effects and promoting long-term tolerability. Frailty scores are now more frequently being incorporated into study design and previous studies, such as RVDlite,7 have demonstrated that upfront dose modifications for standard of care therapies can offer older patients highly active multi-drug combinations with a more limited side effect profile while maintaining comparable efficacy. Despite the fact that these tools can be used to reliably classify patients and predict the risk of treatment- and host-related morbidity and mortality, frailty assessments can be cumbersome and challenging to integrate into clinical practice. Ongoing efforts need to be made to standardize and simplify assessments so that they may be routinely included in the care of older MM patients. Psychosocial Support Maintaining quality of life and ease of treatment delivery are important considerations for all but particularly for older frail patients, especially as treatment patterns shift toward longer durations. Goals of therapy are an important discussion to have with patients with MM. Because MM is not currently curable, it is important to have a meaningful conversation with patients about the balance of maintaining disease control with optimizing quality of life. By treating a patient’s MM, we hope to improve organ function and relieve pain and other disease-related symptoms. We want patients to remain active, functional, and able to pursue the professional or personal activities in life that make them happy and make life meaningful. When considering the frail patient, psychosocial support is equally important for frail adults with MM. Patients with MM diagnosis can experience significant emotional distress8, and frail individuals may experience increased levels of anxiety and depression.9 Providing psychological support, counseling services, and access to support groups can help address the emotional toll of the disease and enhance the patient’s wellbeing and resilience particularly in the frail population. Frail adults with MM may also face heightened complications such as increased susceptibility to infections.10 Combined with frailty, the risk of infections and their potential severity are amplified, making it essential for healthcare providers to closely monitor and manage these individuals’ health. Pain management is another crucial aspect of caring for frail adults with MM. Bone pain is a common symptom of MM. Frail individuals may have a reduced
RkJQdWJsaXNoZXIy MTk3NTQxMg==