The Role of Frailty in MDS Treatment

Many patients with myelodysplastic syndrome (MDS) are older adults, and up to 25% are considered frail or vulnerable at diagnosis due to their advanced age.

What Is Frailty and Why Does It Matter for People with MDS?

Frailty is a state of reduced physiological reserve that makes people more vulnerable to health complications and medication side effects. In MDS, frailty predicts survival better than other disease-related factors and health conditions. This is why it is important that it is considered from diagnosis to adjust and personalize the care needed as much as possible.

How Frailty Impacts Treatment 

For higher-risk MDS patients, hypomethylating agents (HMAs) such as azacytidine or decitabine are standard treatments. Often, HMAs are not offered to frail patients due to concerns about side effects, and when treated with HMAs, frail patients are more likely to stop treatment early, potentially missing the benefits, as it may take 4-6 cycles of HMA therapy to achieve a meaningful response.

Study Findings on Hypomethylating Agents and Frailty

The study presented at the ASH conference investigated how frailty affects survival and the likelihood of completing 4-6 cycles of HMA therapy. The study included 513 patients with MDS or chronic myelomonocytic leukemia (CMML). Here are the key findings:

• The median age was 72.7 years, and 69% were male. 

• 81% of patients completed at least 4 cycles of HMA therapy, and 71% completed 6 cycles. Factors such as higher hemoglobin levels and lower frailty scores predicted better adherence to treatment.

• Half of the patients studied were alive after 1.7 years. Frailty, measured by specific scales, was strongly linked to shorter survival.
  • For example, patients with higher frailty scores on the Rockwood Frailty Scale had a median survival of 1.14 years compared to 2.27 years for less frail patients.

What This Study’s Results Mean for Patients and Caregivers? 

The study highlights the importance of evaluating frailty in MDS patients before starting HMA therapy. Identifying frail patients can:

• Help doctors personalize treatment plans.

• Additional support, such as managing fatigue, improving physical performance, or addressing quality of life issues, is important.

• Open discussions between patients and their healthcare team about alternative therapies if standard treatments pose too much risk.

Takeaway Message

Considering and assessing frailty is critical in determining survival and treatment success in MDS. That’s why patients and caregivers should advocate for comprehensive frailty assessments and support strategies. This study also found that to achieve better outcomes, completing 4-6 cycles of HMA therapy is essential. 

If you or a loved one has MDS, discussing frailty while reviewing treatment options with your healthcare provider can make a significant difference in managing the disease and improving quality of life.

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Source: 

• Impact of Frailty in a Prospective Cohort of Patients with MDS Treated with Hypomethylating Agents