Frailty and Multiple Myeloma | Hira Mian, MD, MSc | ASH 2022

I'm Dr. Mian from McMaster University in Canada. Thank you so much for inviting me. Our group had the privilege of presenting three ash oral abstracts. Two of our abstracts are in this concept of frailty. Now frailty we know is really important in multiple myeloma because it can impact how long patients can live and how they respond to treatment as well as how toxic some of the treatments will be. One of the first concepts we looked at is that there's so many different frailty scores and tools and are they really measuring the same thing? So in one of the first studies that we presented we showed that actually if you use different frailty tools you categorize patients differently as being frail or non-frail. Now that's a bit of a problem because we all really need to be talking a similar language when we talk about frailty and so we really emphasize that there needs to be some form of standardization so we can all compare across studies and all really talk the same language in order to improve patient outcomes. The second abstract that we presented also in fact looked at the similar concept and it looked at this idea of does frailty change over time in multiple myeloma? Now that's really important because you know just how we think of disease assessment, we don't want to just measure these things right at the time of diagnosis. We want to come back, remeasure them again and say if things are changing am I changing my treatment? So in this large study that we did using an administrative database we in fact showed that frailty changes over time in the vast majority of patients. So in our study frailty categorization changed in over 93% of the patients. What was also interesting to note that it could actually improve or worsen so with treatment your functional status can change a lot. So in the future I think the implications of the study will be that we really need to both design clinical trials as well as in the real world clinic not just measure outcomes like frailty at one time point but come back after a few months, remeasure them again and say you know what if things are changing should I potentially escalate or change my treatment options as well? So we really hope that this concept of what I call dynamic frailty will really start to be incorporated into settings. The last abstract that we presented looked at the causes of death in multiple myeloma. So really in older adults you know it's really unclear with really good myeloma regimens what are patients really going to be dying from? And in this study it was really interesting to note again we did this study in a large population setting in Ontario and it was myeloma. Myeloma is the leading cause of death by far among both the younger patients as well as older patients even in the era of novel therapy. So I think this has really important implications because it highlights the fact that we need ongoing development, good therapy for patients that are both younger as well as older to really move the needle and improve survival for patients with myeloma. I think that that was part of our motivation for doing this study because we really wanted to know two things. One is among younger patients and older patients is there a difference in what the leading cause of death is? And then the other thing is as part of the study we really wanted to know the farther you get from diagnosis is myeloma still the problem? And I think that's the important part both in older adults and even for patients that are five years and beyond myeloma is still the leading cause of death in over two thirds of older adults. And that's you know not it's improving but still so much more work needs to be done in that so I thought that was an important conclusion and the motivation for us doing this study.