Hi, my name is Charlotte Paulin. I'm from the Royal Marsden Hospital and the Institute of Cancer Research in London. I'm here at ASH presenting some data from the UK Myeloma Research Alliance fitness trial. This is a trial in which we wanted to explore whether we could use the IMWG frailty score to better determine what dose of particular treatments patients should start their myeloma treatment on. So we recruited 733 patients to the trial and they were randomised between having frailty adapted dosing in one arm of the study or standard dosing in the other arm of the study. The treatments that we gave in both arms were the combination of exacimib, lenalidomide and dexamethasone and in the frailty adjusted arm patients had lower doses that they started taking based on their frailty score. Now the frailty score assesses a combination of factors including age, other medical conditions that the patient might have and also some questionnaires about activities of daily living, how independent a person is. And this score breaks the group of patients down into three groups based on the degree of fitness. And so those patients who were assessed as being less fit, they started on lower doses of treatment in this experimental arm of the trial and the other groups started on higher doses. And that was compared to what we would do as standard or consider standard, which is to start on the approved dose of the drug and then only dose reduce if a patient experienced toxicity. So this trial is a little different to other trials where we're comparing one treatment to another. We're comparing a strategy, a dosing strategy to standard dosing. Overall, we were trying to see whether starting on a frailty adjusted dosing approach would reduce the number of patients who had to stop treatment early because of side effects or other reasons. And overall we didn't see a difference in that measure, but we did see a difference in the intermediate fitness group of patients. Those patients did seem to benefit from having this frailty adjusted dosing approach, but those patients who were least fit, they're labeled as frail by this scoring system. Those patients didn't seem to benefit so much from starting with a lower dose, but really importantly, they didn't have worse outcomes than the patients who started on a standard dose. And that's really critical because some people have already started to use this dose adapted approach in their clinic. And so it was important that we didn't detect that was associated with any shorter outcomes for patients. So overall, we found that we didn't meet the primary end point of the study, which was to show a significant difference in early treatment cessation across the whole cohort. But we presented some interesting findings about specific groups in particular. So there were some differences between those patients who were classified as frail and those in the intermediate group. If our videos have helped you in any way, and you're able to, please consider making a donation to help us continue this important work. Your gift will go three times as far when we reach $500,000 by the end of the year. Every contribution, big or small, makes a difference, and we're deeply grateful for your support.
HealthTree • December 20, 2025