scholarly journals N‐terminal fragment of the type‐B natriuretic peptide (NT‐proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma

2016 ◽  
Vol 91 (11) ◽  
pp. 1129-1134 ◽  
Author(s):  
Paolo Milani ◽  
S. Vincent Rajkumar ◽  
Giampaolo Merlini ◽  
Shaji Kumar ◽  
Morie A. Gertz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Natriuretic Peptide ◽  
Newly Diagnosed ◽  
Type B ◽  
Terminal Fragment ◽  
Frailty Score

COMPARISON OF FRAILTY SCORES IN NEWLY DIAGNOSED PATIENTS WITH MULTIPLE MYELOMA: A REVIEW

2019 ◽  
pp. 1-7 ◽  
Author(s):  
H. Mian ◽  
M. Brouwers ◽  
C.T. Kouroukis ◽  
T.M. Wildes
Keyword(s):  
Multiple Myeloma ◽  
Older Patients ◽  
Treatment Options ◽  
Clinical Settings ◽  
Newly Diagnosed ◽  
Future Directions ◽  
Malignant Plasma Cell ◽  
Co Morbidity ◽  
Morbidity Index ◽  
Frailty Score

Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The challenge in treating older patients is to accurately identify ‘fit’ patients that can tolerate more intensive treatment to maximize disease control, while simultaneously identifying vulnerable or ‘frail’ patients who may develop toxicity with significant morbidity and mortality, requiring different treatment options or dose modification. Multiple frailty scores have been devised for multiple myeloma over the years in newly-diagnosed patients. This paper gives an overview of the three common frailty measurements: the International Myeloma Working Group Frailty Score, Mayo Clinic Frailty Score and the Revised Myeloma Co-Morbidity Index. We will summarize the derivation, validation, usability and applicability of these scores in different clinical settings, emphasizing the main strengths and limitations for each index score. We will also highlight future directions in the operationalization of frailty in multiple myeloma.

scholarly journals Octogenarian newly diagnosed multiple myeloma patients without geriatric impairments: the role of age >80 in the IMWG frailty score

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Mattia D’Agostino ◽  
Alessandra Larocca ◽  
Massimo Offidani ◽  
Anna Marina Liberati ◽  
Gianluca Gaidano ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Newly Diagnosed ◽  
Frailty Score

scholarly journals N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) Is Associated with Both Left Ventricular Diastolic Dysfunction and Myeloma-Related Renal Insufficiency and Robustly Predicts Mortality in Patients with Symptomatic Multiple Myeloma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4478-4478
Author(s):  
Yoshiaki Abe ◽  
Tetsuya Kobayashi ◽  
Kentaro Narita ◽  
Hiroki Kobayashi ◽  
Akihiro Kitadate ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Insufficiency ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Light Chain ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Al Amyloidosis ◽  
Newly Diagnosed ◽  
Renal Functions

Abstract Background: AlthoughN-terminal pro-brain natriuretic peptide (NT-proBNP) is an established biomarker as a prognostic predictor in patients with light-chain (AL) amyloidosis, its prognostic value and association with cardiac or renal functions remain unclear in patients with symptomatic multiple myeloma (MM). The aims of this study included to validate the prognostic significance of the baseline NT-proBNP levels comparing with the brain natriuretic peptide (BNP) levels and to identify clinical factors and mechanisms which are reflected by NT-proBNP and more directly affect mortality in newly diagnosed, symptomatic MM. Methods: We retrospectively analyzed prognostic relevance of NT-proBNP in comparison with brain natriuretic peptide (BNP) and its association with cardiac functions on echocardiography or renal functions in 153 consecutive patients with newly diagnosed, symptomatic MM who were diagnosed and treated with chemotherapy between April 2008 to March 2018 at Kameda Medical Center, Kamogawa, Japan. We included only patients who had been treated with novel agents. Patients with pathologically proven organ involvement with light-chain (AL) amyloidosis were excluded from the analysis. The presence of LV diastolic dysfunction (LVDD) was determined individually according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Results: Median age of the patients was 74.2 years [interquartile range (IQR): 66.7-80.8 years]. The median observation period was 26.4 months (IQR: 10.8-49.1 months). Receiver operating characteristic(ROC) curves for BNP and NT-proBNP predicting the highest risk of death within five years were shown in Figure 1A and 1B, respectively. According to the ROC analysis, the optimal cutoff of NT-proBNP was determined as 341.0 pg/ml. The comparison of area under curve (AUC) between BNP and NT-proBNP was shown in Figure 1C. The AUC was significantly greater for NT-proBNP than for BNP (0.818 vs. 0.731; P=0.024).Subsequently, we divided patients into two patient groups with lower (n=83) and higher (n=68) NT-proBNP according to the cutoff. Patients with higher NT-proBNP were significantly older, had poorer performance status, Instrumental Activity of Daily Living and Charlson Comorbidity Index scores, and included more patients with higher disease stages. Notably, patients with higher NT-proBNP included more patients with LVDD than patients with lower NT-proBNP (71.4% vs. 33.3%, respectively; P<0.001, Figure 2A), and all diastolic function-related parameters showed associations with NT-proBNP, although the difference in septal e' did not reach statistical significance (Figure 2B-E). However, there was no significant difference in left ventricular ejection fraction between patients with lower and higher NT-proBNP (Figure 2F). We also investigated the association between NT-proBNP and myeloma-related renal insufficiency shown in Figure 3. Patients with higher NT-proBNP included more patients with renal insufficiency (58.8% vs. 15.3%, respectively; P<0.001) or light-chain cast nephropathy (41.2% vs. 8.2%, respectively; P<0.001) with their involved free-light chain and corrected calcium levels significantly higher than patients with lower NT-proBNP (Figure 3A-D). Patients with higher NT-proBNP showed significantly shorter overall survival (OS) than those with lower NT-proBNP (median: 33.6 months and not reached, respectively; P<0.001, Figure 4). NT-proBNP levels discriminated patients with significantly different survivals even in both younger (<75 years) and older (≥75 years)patients or in both patients with and without decreased renal functions (estimated glomerular filtration rate ≥ and <50 ml/min/1.73m2).Furthermore, NT-proBNP retained its significant prognostic value for OS on multivariate analysis with the highest hazard ratio (HR) (HR; 7.66, 95% confidence interval; 3.52-16.68, P<0.001) (Table 1). Conclusions: Our findings revealed that the NT-proBNP levels were associated with both LVDD as a host risk factor and myeloma-related renal insufficiency resulting from aggressive disease nature and consequently provided a robustly predictive information for OS in patients with symptomatic MM who did not harbor concomitant AL amyloidosis. Further studies should explore the synergistic prognostic potential of NT-proBNP. Disclosures No relevant conflicts of interest to declare.

scholarly journals The IMWG Frailty Score and Age Can be More Effective Than Clinical Judgement in the Selection of Elderly Patients with Newly Diagnosed Multiple Myeloma Who Can Benefit from an Intensive Treatment Approach with High Dose Melphalan and Autologous Stem Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2151-2151 ◽  
Author(s):  
Angelo Belotti ◽  
Rossella Ribolla ◽  
Valeria Cancelli ◽  
Nicola Bianchetti ◽  
Claudia Crippa ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Advisory Board ◽  
Clinical Judgement ◽  
Newly Diagnosed ◽  
Comorbidity Index ◽  
Frailty Score ◽  
Better Than

Abstract Introduction: Autologous stem cell transplantation (ASCT) has proven effective in Multiple Myeloma (MM) patients (pts) aged <65. However in several studies ASCT has proven safe and effective also in selected MM pts aged >65. With the increase of treatment options, several geriatric assessment tools have been proposed to help physicians in selecting treatment of appropriate intensity. However specific criteria for evaluating ASCT eligibility in elderly MM pts have been seldom investigated.Patients and Methods: From January 2013 to December 2017 131 consecutive newly diagnosed symptomatic MM pts aged 65-75 (M/F: 66/65) were considered for ASCT at our center according to physician's clinical judgement. The variables included in Charlson Comorbidity Index (CCI), Hematopoietic cell transplantation comorbidity index (HCT-CI), and International Myeloma Working Group (IMWG) frailty score were not considered for selection but were retrieved for this study and pts were classified accordingly. Of note, ADL and IADL were referred to pts status prior the occurrence of MM related symptoms. The impact of age and the predictive role of the above mentioned scores on progression-free survival (PFS) of pts selected or not for ASCT was analyzed. Pts characteristics are shown in Table 1. Results: Of 131 pts, 85 (65%) were judged transplant eligible (ASCT ITT arm) by the clinician and received bortezomib-based induction (VTD 94%, VD 5%, VCD 1%); 72 of them (85%) actually underwent ASCT (70% single, 30% double) with melphalan conditioning 200 mg/sqm in 68% of cases. The 46 pts considered ineligible to ASCT received a less intensive first line treatment (89% VMP, 4% Daratumumab-VMP, 2% MP, 5% steroids/palliation). Complete remission (CR) after the first ASCT was higher in the ASCT (ITT) vs the NO ASCT group (43,5% vs 26%, respectively; p 0.048), whereas ORR and ³VGPR rates were comparable (83% vs 74% and 76,4% vs 61%, respectively). Transplant related mortality (TRM) was 0%. 2 year death rate was 13% in the ASCT (ITT) arm and was due to PD in 91% of cases (the latter 9% concerns a cardiac arrest secondary to aspiration pneumonia in a pt in VGPR 3 months after first ASCT). After a median follow-up of 27 months, PFS was 35,6 in the ASCT (ITT) group vs 19,9 months in NO ASCT pts, respectively; p 0,013, HR 0,42 (95% CI: 0,25-0,71). HCT-CI was ≥2 in 87% of pts overall. PFS was better in pts with HCT-CI 0-1 compared to HCT≥2 (NR vs 27,3 months; p 0,025, HR 0,45, 95% CI 0,23-0,91) and also in pts with HCT-CI ³2 undergoing ASCT (ITT) than in NO ASCT pts: median 34 vs 19,9 months, p 0,008 (HR 0,5, 95%CI 0,30-0,84). CCI was 0-3 in 78% of pts. Their outcome according was similar to pts with CCI >3 but ASCT performed better than NO ASCT also in the few (median PFS 51,4 vs 16,9 months; p 0,04, HR 0,37, 95%CI 0,15-0,95). IMWG frailty score was more useful. No pts classified as FRAIL had been considered eligible to ASCT by clinical decision with a significantly worse outcome compared to FIT and UNFIT pts (median PFS: 7,9 months vs 32,9 and 29,6; FIT vs FRAIL: p < 0.0001, HR 0,02, 95%CI 0,004-0,008; UNFIT vs FRAIL: p < 0,001, HR 0,03 95%CI 0,007-0,12). Unlike HCT-CI and CCI, the distribution of patients according to IMWG score was more balanced both overall and between the ASCT (ITT) and NO ASCT groups, particularly for UNFIT pts. However on the whole no outcome differences were observed between FIT and UNFIT pts. PFS was better in FIT&UNFIT pts in the ASCT (ITT) group than in the NO ASCT group: median 35,6 months vs 25,8 months; p 0,04, HR 0,54, 95%CI 0,31-0,97. However, in the ASCT (ITT) group, the age group 65-69 years fared better than pts ³70 years (51,5 vs 27,7 months, p 0,0037; HR 0.34, 95% CI 0.17-0.7). Indeed, in IMWG UNFIT patients aged ³70, the PFS of the ASCT (ITT) group was comparable to NO ASCT group (18 vs 27 months, p 0,33) whereas in UNFIT pts aged 65-69, PFS was superior in pts treated more intensively by physician choice: 43,3 months in ASCT (ITT) arm vs 18,4 months in NO ASCT (p 0.01, HR 0.03; 95%CI 0.003-0.24). Conclusion: In an unselected series of elderly MM pts aged 65-75 and undergoing ASCT according to clinical judgement the outcome of ASCT pts was better than those of NO ASCT. CCI and HCT-CI score proved of little help for better identifying the best candidates to ASCT. Conversely the IMWG frailty score would be of help in identifying the category of UNFIT pts aged 70-75 whose outcome with ASCT selected by clinical judgement was no better than with less intensive treatments. Table 1: Disclosures Belotti: Amgen: Other: Advisory Board; Celgene: Other: Advisory Board. Cattaneo:GILEAD: Other: Advisory Board. Rossi:TEVA: Other: ADVISORY BOARD; CELGENE: Other: ADVISORY BOARD; SANOFI: Other: ADVISORY BOARD; MUNDIPHARMA: Honoraria; ABBVIE: Other: ADVISORY BOARD; JANNSEN: Other; PFIZER: Other: ADVISORY BOARD; ROCHE: Other: Advisory Board; NOVARTIS: Honoraria; SANDOZ: Honoraria; GILEAD: Other: ADVISORY BOARD; BMS: Honoraria; JAZZ: Other: ADVISORY BOARD; AMGEN: Other: ADVISORY BOARD.

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