While the International Myeloma Working Group (IMWG) Index was validated in scoring patients with newly diagnosed multiple myeloma, its relevance for patients with relapsed or refractory multiple myeloma was uncertain. Therefore, Fabio Efficace, PhD, and a team of researchers investigated IMWG frailty scoring in patients with previously treated disease. Their study, presented at the 2021 American Society of Hematology Annual Meeting and Exposition, reported that the IMWG was able to identify distinct patient-reported health-related quality of life (HRQOL) profiles in relapsed/refractory disease, as well.
According to Dr. Efficace, the study’s results “may lay the groundwork for the development of a patient-centered frailty index, which also incorporates HRQOL data, to be used in patients with relapsed/refractory multiple myeloma treated in real life.”
The observational study enrolled 365 patients with relapsed/refractory multiple myeloma from 30 centers and classified them into three frailty groups: fit, intermediate-fit, and frail. The participants regularly completed validated reporting tools including the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its myeloma module (QLQ-MY20).
Based on their IMWG frailty score at enrollment, 192 (53%), 85 (23%), and 88 (24%) patients were classified as fit, intermediate-fit, and frail, respectively. Researchers observed distinct HRQOL profiles between the three groups, which supported the IMWG’s initial categorization. For example, mean EORTC QLQ-C30 physical functioning mean scores were 71.2 for fit, 62.2 for intermediate-fit, and 47.5 for frail patients (p < 0.001). Additionally, mean scores on the QLQ-MY20 disease symptom scale were 22.8, 25.9, and 35.9 for fit, intermediate-fit, and frail patients, respectively (p < 0.001). Further, the frequency of patient-reported clinically important symptoms differed significantly across the groups for pain (p = 0.002), dyspnea (p = 0.004), fatigue (p < 0.001), insomnia (p = 0.022) constipation (p = 0.003), and appetite loss (p = 0.001).
Based on the associations between the IMWG’s frailty categories and the groups’ respective scores on other HRQOL measures, the study’s authors judged that the IMWG frailty scoring was effective in both relapsed/refractory and newly diagnosed multiple myeloma.