The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review
Abstract Multiple myeloma (MM) is an incurable blood cancer that primarily affects older adults. Several frailty tools have been developed to address the heterogeneity of aging in this population. Uptake of these measures has been variable, leading to a gap in knowledge regarding the proportion of e...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Publishing Group
2023-01-01
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| Series: | Blood Cancer Journal |
| Online Access: | https://doi.org/10.1038/s41408-022-00779-2 |
| _version_ | 1797958781417553920 |
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| author | Hira Mian Arleigh McCurdy Smith Giri Shakira Grant Bram Rochwerg Erica Winks Ashley E. Rosko Monika Engelhardt Charlotte Pawlyn Gordon Cook Graham Jackson Sara Bringhen Thierry Facon Alessandra Larocca Sonja Zweegman Tanya M. Wildes |
| author_facet | Hira Mian Arleigh McCurdy Smith Giri Shakira Grant Bram Rochwerg Erica Winks Ashley E. Rosko Monika Engelhardt Charlotte Pawlyn Gordon Cook Graham Jackson Sara Bringhen Thierry Facon Alessandra Larocca Sonja Zweegman Tanya M. Wildes |
| author_sort | Hira Mian |
| collection | DOAJ |
| description | Abstract Multiple myeloma (MM) is an incurable blood cancer that primarily affects older adults. Several frailty tools have been developed to address the heterogeneity of aging in this population. Uptake of these measures has been variable, leading to a gap in knowledge regarding the proportion of enrolled trial participants considered frail and uncertainty in the treatment-related effects and outcomes among this high-risk population. We performed a systematic review of therapeutic interventional MM clinical trials reporting on frailty. We included 43 clinical trials (24 randomized controlled trials and 19 non-randomized trials) which met eligibility criteria. Frailty was increasingly incorporated in studies in more recent years with 41.9% of included studies being reported in the last two years. Commonly used frailty tools included the International Myeloma Working Group (IMWG) frailty index (41.8%), and the simplified frailty score (39.5%). Frailty status was categorized with 3 levels as (frail, intermediate fit, or fit) in 51.2% of the studies and dichotomized (frail, non-frail) in 18.6% of studies. Frailty prevalence greatly varied across trials ranging from 17.2% to 73.6% of the cohort. Of the included studies, 72.0% conducted subgroup analysis (planned or post-hoc) based on frailty status. Most studies demonstrated a consistent benefit of MM interventions among the frail and non-frail populations, however in general, frail patients had worse outcomes compared to the fit. Although frailty is increasingly being incorporated in MM clinical trials, due to the variation in both the definition and categorization of frailty, there remains heterogeneity in the prevalence of frailty and its potential associated impact on outcomes. |
| first_indexed | 2024-04-11T00:23:36Z |
| format | Article |
| id | doaj.art-076d33876b5743238d8aecfa4776d328 |
| institution | Directory Open Access Journal |
| issn | 2044-5385 |
| language | English |
| last_indexed | 2024-04-11T00:23:36Z |
| publishDate | 2023-01-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Blood Cancer Journal |
| spelling | doaj.art-076d33876b5743238d8aecfa4776d3282023-01-08T12:05:10ZengNature Publishing GroupBlood Cancer Journal2044-53852023-01-0113111310.1038/s41408-022-00779-2The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic reviewHira Mian0Arleigh McCurdy1Smith Giri2Shakira Grant3Bram Rochwerg4Erica Winks5Ashley E. Rosko6Monika Engelhardt7Charlotte Pawlyn8Gordon Cook9Graham Jackson10Sara Bringhen11Thierry Facon12Alessandra Larocca13Sonja Zweegman14Tanya M. Wildes15Department of Oncology, McMaster UniversityDepartment of Medicine, The Ottawa HospitalDepartment of Medicine, University of Alabama at BirminghamDepartment of Medicine, Division of Hematology, The University of North Carolina at Chapel HillDepartment of Medicine, McMaster UniversityDepartment of Oncology, McMaster UniversityDivision of Hematology, The Ohio State UniversityHematology and Oncology Department, Interdisciplinary Cancer Center (ITZ) and Comprehensive Cancer Center Freiburg (CCCF), Faculty of Freidburg, University of FreiburgThe Institute of Cancer Research and Royal Marsden Hospital NHS Foundation TrustCancer Research UK Clinical Trials Unit, LICTR, University of LeedsNorthern Centre for Cancer Care, Newcastle Upon Tyne Hospitals TrustSSD Clinical Trial in Onco-hematology and Multiple Myeloma, AOU City of Health and Science of TurinUniversity of Lille, CHU Lille, Service des Maladies du SangSSD Clinical trials in onco-ematologia e mieloma multiplo, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di TorinoDepartment of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center AmsterdamDivision of Hematology/Oncology, University of Nebraska Medical CenterAbstract Multiple myeloma (MM) is an incurable blood cancer that primarily affects older adults. Several frailty tools have been developed to address the heterogeneity of aging in this population. Uptake of these measures has been variable, leading to a gap in knowledge regarding the proportion of enrolled trial participants considered frail and uncertainty in the treatment-related effects and outcomes among this high-risk population. We performed a systematic review of therapeutic interventional MM clinical trials reporting on frailty. We included 43 clinical trials (24 randomized controlled trials and 19 non-randomized trials) which met eligibility criteria. Frailty was increasingly incorporated in studies in more recent years with 41.9% of included studies being reported in the last two years. Commonly used frailty tools included the International Myeloma Working Group (IMWG) frailty index (41.8%), and the simplified frailty score (39.5%). Frailty status was categorized with 3 levels as (frail, intermediate fit, or fit) in 51.2% of the studies and dichotomized (frail, non-frail) in 18.6% of studies. Frailty prevalence greatly varied across trials ranging from 17.2% to 73.6% of the cohort. Of the included studies, 72.0% conducted subgroup analysis (planned or post-hoc) based on frailty status. Most studies demonstrated a consistent benefit of MM interventions among the frail and non-frail populations, however in general, frail patients had worse outcomes compared to the fit. Although frailty is increasingly being incorporated in MM clinical trials, due to the variation in both the definition and categorization of frailty, there remains heterogeneity in the prevalence of frailty and its potential associated impact on outcomes.https://doi.org/10.1038/s41408-022-00779-2 |
| spellingShingle | Hira Mian Arleigh McCurdy Smith Giri Shakira Grant Bram Rochwerg Erica Winks Ashley E. Rosko Monika Engelhardt Charlotte Pawlyn Gordon Cook Graham Jackson Sara Bringhen Thierry Facon Alessandra Larocca Sonja Zweegman Tanya M. Wildes The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review Blood Cancer Journal |
| title | The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review |
| title_full | The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review |
| title_fullStr | The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review |
| title_full_unstemmed | The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review |
| title_short | The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: A systematic review |
| title_sort | prevalence and outcomes of frail older adults in clinical trials in multiple myeloma a systematic review |
| url | https://doi.org/10.1038/s41408-022-00779-2 |
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