P949: combination ga and mpr vulnerability scoring tools effectively improve the ability to identify the frail elderly patients with newly diagnosed multiple myeloma

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: The International Myeloma Working Group (IMWG) developed a geriatric assessment (GA) based frailty index (IMWG-FI) using age, comorbidities, and physical function (instrumental activities of daily living, IADL; activities of daily living, ADL) to predict risk of toxicity and mortality among older patients with multiple myeloma (MM) (Palumbo, et al., Blood 2015). Because of its subjectivity and relative complexity，efforts are ongoing to simplify the IMWG frailty score and improve its discriminative ability. Aims: Combine GA and other vulnerability scoring tools to evaluate their consistency in the frail elderly patients with newly diagnosed multiple myeloma (NDMM) and develop a more effective vulnerability scoring system to improve their ability to identify the frail elderly patients with NDMM. Methods: 120 frail elderly newly diagnosed MM patients, defined by GA score in multicenter prospective clinical study (ClinicalTrials.gov number, chiCTR1900024917), were further stratified and evaluated by other four vulnerability scoring systems, including R-MCI, Facen vulnerability scale, MAYO vulnerability scale, and MPR Myeloma Risk Alliance, and the PFS and OS of these 120 patients under different scores were compared to evaluate the effectiveness of these vulnerability scores. Results: 43.3%(51/120), 90%(108/120), 29.7%(32/120) and 65.8%(79/120) of the 120 patients were identified as fragile after reassessed by R-MCI, Faceon, Mayo and MPR frailty scale. 16.7%patients (20/120) met the vulnerability assessment of 5 scales at the same time. 48 patients died, including 20 cases of R-MCI fragility, 43 cases of Facen fragility, 18 cases of MAYO fragility, and 34 cases of MPR fragility. Of note，the analysis of OS and PFS in the 120 elderly patients with NDMM showed differences in survival after stratified by MPR assessment. MPR fit 11.7%cases (14/120), intermediate-fit 22.5% cases (27/120), and frail 65.8% cases (79/120), this means only 65.8% of patients identified fragile by GA score meet vulnerability criteria of MPR. The median OS in fit group was significantly better than frail group (34.3m vs not reached, p=0.026). 4 early deaths within 60 days are fragile according to the MPR scores. Of 79 MPR frail patients, 74.7% (59/79) GA score 2 points, 21.5% (17/79) GA score 3 points, 2.5% (2/79) GA score 4 points, and 1.25% (1/79) GA score 5 points, while 14 MPR fit patients met GA score 2 points. There was no statistical difference in OS between fit and frail group after re-evaluated with R-MCI, Facon, Mayo vulnerability score. There was no statistical difference in the median PFS among the subgroups. Summary/Conclusion: This is a unique study by directly comparing IMWG frailty score with other multiple frailty scores. We demonstrated that the combination GA and MPR vulnerability scoring tools more effectively improve the ability to identify the frail elderly patients with NDMM.Keywords: Elderly, Multiple myeloma