Clinical impacts of frailty, poor performance status, and advanced age in carfilzomib-containing treatment for relapsed/refractory multiple myeloma: post hoc investigation of the KOTOSG multicenter pilot prospective observational study

• Published in: International journal of hematology Vol. 115; no. 3; pp. 350 - 362
• Main Authors: Kawaji-Kanayama, Yuka, Muramatsu, Ayako, Sasaki, Nana, Shimura, Kazuho, Kiyota, Miki, Fuchida, Shinichi, Isa, Reiko, Fujino, Takahiro, Matsumura-Kimoto, Yayoi, Tsukamoto, Taku, Chinen, Yoshiaki, Mizutani, Shinsuke, Nakao, Mitsushige, Kaneko, Hiroto, Kawata, Eri, Hirakawa, Koichi, Takahashi, Ryoichi, Shimazaki, Chihiro, Uchiyama, Hitoji, Uoshima, Nobuhiko, Shimura, Yuji, Kobayashi, Tsutomu, Taniwaki, Masafumi, Kuroda, Junya
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.03.2022; Springer Nature B.V
• Subjects: Adult; Age; Age Factors; Aged; Aged, 80 and over; Anemia; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Criteria; Female; Frailty; Frailty - etiology; Hematology; Humans; Inhibitor drugs; Lymphopenia; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Multicenter Studies as Topic; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - mortality; Neoplasm Recurrence, Local; Observational studies; Observational Studies as Topic; Oligopeptides - adverse effects; Oligopeptides - therapeutic use; Oncology; Original Article; Patients; Pilot Projects; Presenilin 2; Prognosis; Prospective Studies; Psychomotor Performance - drug effects; Risk; Safety; Survival Rate; Targeted cancer therapy; Treatment Outcome; Carfilzomib; Frailty; Advanced age; Performance status; Multiple myeloma
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-021-03262-z

We conducted a post hoc analysis of our previous pilot observational study on the efficacy and safety of carfilzomib (CFZ)-containing therapy in 50 patients with relapsed/refractory multiple myeloma in routine practice to clarify the relationships between three major criteria for vulnerability (frailty, poor performance status [PS], and advanced age [≥ 75 years]) and their clinical impact on efficacy and adverse events (AEs). Sixteen patients fulfilled at least one and five patients fulfilled all three criteria. The overall response rate was not significantly affected by frailty, poor PS, and/or advanced age; however, frailty and advanced age were significantly associated with shorter progression-free survival (PFS). In contrast, no significant difference in PFS was observed between patients with PS0–1 or PS2–4. The three criteria for vulnerability were associated with more frequent hematologic AEs: frailty, poor PS, and/or advanced age significantly increased the risk of grade 3–4 anemia and lymphopenia. However, these criteria were not associated with increased risk of other non-hematologic AEs except infection. Collectively, these results demonstrate the need to carefully manage severe hematologic AEs in vulnerable patients and perform disease-specific assessment of frailty to predict prognosis.