Myeloma Frailty Score

Palumbo, Antonio et al “Geriatric assessment predicts survival and toxicities in elderly myeloma: an International Myeloma Working Group report.” Blood (2015): blood-2014-12-615187.

The score system (range 0-5), based on age, comorbidities, cognitive and physical conditions, developed by Palumbo A. et al1, identifies 3 groups of patients:

  • fit (score = 0)
  • intermediate-fitness (score = 1)
  • frail (score ≥ 2)

The 3-year overall survival was 84% in fit patients, 76% in intermediate-fitness patients (HR 1.61, 95%CI 1.02-2.56, p=0.042) and 57% in frail patients (HR 3.57 CI 95% 2.37-5.39, p<0.001). The cumulative incidence of grade ≥3 non-hematologic adverse events at 12 months was 22.2% in fit, 26.4% in intermediate-fitness (HR 1.23, 95%CI 0.89-1.71; p 0.217) and 34.0% (HR 1.74, 95%CI 1.28-2.38; p<0.001) in frail patients. The cumulative incidence of treatment discontinuation at 12 months was 16.5% in fit, 20.8% in intermediate-fitness (HR 1.41, 95%CI 1.00-2.01, p=0.052) and 31.2% (HR 2.21, 95%CI 1.57-3.09; p<0.001) in frail patients.

This frailty score predicts mortality and the risk of toxicity in elderly myeloma patients. The International Myeloma Working group proposes this score for the measurement of frailty in the treatment decision-making process and in designing future clinical trials.

Answer the following questions, and the Myeloma Frailty Score will be calculated at the end.

Charlson Score

None Without end organ damage With end organ damage
None Mild Moderate Severe
None Mild Moderate Severe
None Non-metastatic Metastatic
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BADL

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IADL

Operates telephone on own initiative - looks up and dials numbers, etc. Dials a few well-known numbers Answers telephone but does not dial Does not use telephone at all
Takes care of all shopping needs independently Shops independently for small purchases Needs to be accompanied on any shopping trip Completely unable to shop
Plans, prepares, and serves adequate meals independently Prepares adequate meals if supplied with ingredients Heats, serves and prepares meals, or prepares meals, or prepares meals but does not maintain adequate diet Needs to have meals prepared and served
Maintains house alone or with occational assistance (e.g. 'heavy domestic work help') Performs light daily tasks such as dish washing, bed making Performs light daily tasks but cannot maintain acceptable level of cleanliness Needs help with all home maintenance tasks Does not participate in any housekeeping tasks
Does personal laundry completely Launders small items - rinses stockings, etc. All laundry must be done by others
Travels independently on public transportation or drives own car Arranges own travel via taxi, but does not otherwise use public transportation Travels on public transportation when accompanied by another Travel limited to taxi or automobile with assitance of another Does not travel at all
Is responsible for taking medication in correct dosages at correct time Takes responsiblity if medication is prepared in advance in separate dosage Is not capable of dispensing own medication
Manages financial matters independently (budgets, writes checks, pays rent, etc.), collects and keeps track of income Manages day-to-day purchases, but needs help with banking, major purchases, etc. Incapable of handling money
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