Individualized dynamic frailty-tailored therapy (DynaFiT) in elderly patients with newly diagnosed multiple myeloma: a prospective study

IF 29.5 1区医学 Q1 HEMATOLOGY

Journal of Hematology & Oncology Pub Date : 2024-06-24 DOI:10.1186/s13045-024-01569-y

Yingjie Zhang, Xinyue Liang, Weiling Xu, Xingcheng Yi, Rui Hu, Xintian Ma, Yurong Yan, Nan Zhang, Jingxuan Wang, Xiaoxiao Sun, Yufeng Zhu, Mengru Tian, Maozhuo Lan, Mengtuan Long, Yun Dai, Fengyan Jin

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引用次数: 0

Abstract

It remains a substantial challenge to balance treatment efficacy and toxicity in geriatric patients with multiple myeloma (MM), primarily due to the dynamic nature of frailty. Here, we conducted a prospective study to evaluate the feasibility and benefits of dynamic frailty-tailored therapy (DynaFiT) in elderly patients. Patients with newly diagnosed MM (aged ≥ 65 years) received eight induction cycles of bortezomib, lenalidomide, and dexamethasone (daratumumab was recommended for frail patients), with treatment intensity adjusted according to longitudinal changes in the frailty category (IMWG-FI) at each cycle. Of 90 patients, 33 (37%), 16 (18%), and 41 (45%) were fit, intermediate fit, and frail at baseline, respectively. Of 75 patients who had geriatric assessment at least twice, 28 (37%) experienced frailty category changes at least once. At analysis, 15/26 (58%) frail patients improved (27% became fit and 31% became intermediate fit), 4/15 (27%) intermediate fit patients either improved or deteriorated (two for each), and 6/30 (20%) fit patients deteriorated. During induction, 34/90 (38%) patients discontinued treatment, including 10/33 (30%) fit, 4/16 (25%) intermediate fit, and 20/41 (49%) frail; 14/40 (35%) frail patients discontinued treatment within the first two cycles, mainly because of non-hematologic toxicity (mostly infections). For fit, intermediate-fit, and frail patients, the overall response rate was 100%, 93%, and 73%, respectively; one-year overall survival was 90%, 75%, and 54%, respectively. Therefore, the individualized DynaFiT is feasible and promising for heterogeneous elderly patients.

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新诊断多发性骨髓瘤老年患者的个体化动态虚弱定制疗法（DynaFiT）：一项前瞻性研究

如何平衡老年多发性骨髓瘤（MM）患者的疗效和毒性仍然是一项巨大的挑战，这主要是由于虚弱的动态性质。在此，我们开展了一项前瞻性研究，以评估老年患者接受动态虚弱定制疗法（DynaFiT）的可行性和益处。新确诊的 MM 患者（年龄≥ 65 岁）接受了 8 个周期的硼替佐米、来那度胺和地塞米松诱导治疗（体弱患者推荐使用达拉单抗），每个周期的治疗强度根据体弱类别（IMWG-FI）的纵向变化进行调整。在90名患者中，基线时体弱、中等体弱和虚弱的患者分别为33人（37%）、16人（18%）和41人（45%）。在至少接受过两次老年评估的 75 名患者中，28 人（37%）的虚弱类别至少发生过一次变化。分析结果显示，15/26（58%）名体弱患者的体质有所改善（27%的患者体质变得健康，31%的患者体质变得中等健康），4/15（27%）名体质中等患者的体质有所改善或恶化（各占两名），6/30（20%）名体质健康患者的体质恶化。在诱导期间，34/90（38%）名患者中止了治疗，其中包括 10/33（30%）名体质良好的患者、4/16（25%）名体质中等的患者和 20/41（49%）名体质虚弱的患者；14/40（35%）名体质虚弱的患者在前两个周期内中止了治疗，主要原因是非血液学毒性（主要是感染）。体格健壮、中等体格和体弱患者的总反应率分别为 100%、93% 和 73%；一年总生存率分别为 90%、75% 和 54%。因此，个体化的 DynaFiT 对异质性老年患者是可行的，也是有前景的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hematology & Oncology 医学-血液学

CiteScore

48.10

自引率

2.10%

发文量

169

审稿时长

6-12 weeks

期刊介绍： The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts. Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.