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. 2025 Mar 11;9(5):1137-1146.
doi: 10.1182/bloodadvances.2024014624.

Cumulative deficits frailty index and relationship status predict survival in multiple myeloma

Nadine Abdallah  1 , Paul Dizona  2 , Amanika Kumar  3 , Betsy LaPlant  2 , Terri Menser  4 , Gavin Schaeferle  4 , Sarah Aug  1 , Megan Weivoda  1 , Angela Dispenzieri  1 , Francis K Buadi  1 , Rahma Warsame  1 , Joselle Cook  1 , Martha Q Lacy  1 , Suzanne Hayman  1 , Morie A Gertz  1 , S Vincent Rajkumar  1 , Shaji K Kumar  1
Affiliations

Cumulative deficits frailty index and relationship status predict survival in multiple myeloma

Nadine Abdallah et al. Blood Adv. .

Abstract

Several tools have been proposed for assessing frailty in multiple myeloma (MM), but most are based on clinical trial data sets. There are also limited data on the association between frailty and patient-reported outcomes and on the prognostic value of social determinants of health. This study evaluates the prognostic impact of frailty, based on the cumulative deficit frailty index (FI), and relationship and socioeconomic status (SES) in patients with newly diagnosed MM. This retrospective study included 515 patients with MM seen at Mayo Clinic (Rochester, MN) at diagnosis between 2005 and 2018. The FI was calculated using patient-reported data on activities of daily living and comorbidity data, with items scored as 0, 0.5, or 1, in which 1 indicated a deficit. The FI was calculated by dividing the total score by the number of nonmissing items. Frailty was defined as FI ≥0.15; 61% were nonfrail, and 39% were frail. Frailty and nonmarried/relationship status were associated with higher disease stage, decreased the likelihood of early transplantation, and independently associated with decreased survival. SES was not independently associated with survival. Frail patients reported worse scores for fatigue, pain, and quality of life. Approximately a quarter of patients had a deterioration in frailty status at 3 to 12 months, and <10% had improvement. In conclusion, a cumulative deficit FI was associated with higher symptom burden and decreased survival in a real-world cohort of patients with newly diagnosed MM. Frailty status is dynamic and should be reassessed during treatment. Social support has prognostic value and should be evaluated in clinical practice.

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Conflict of interest statement

Conflict-of-interest disclosure: A.D. received research funding from Celgene, Millennium Pharmaceuticals, Pfizer, and Janssen, and a travel grant from Pfizer. M.A.G. served as a consultant for Millennium Pharmaceuticals and received honoraria from Celgene, Millennium Pharmaceuticals, Onyx Pharmaceuticals, Novartis, GlaxoSmithKline, Prothena, Ionis Pharmaceuticals, and Amgen. M.Q.L. received research funding from Celgene. S.V.R. received grants from the National Institutes of Health and research funding from Celgene for clinical trials. S.K.K. served as a consultant for Celgene, Millennium Pharmaceuticals, Onyx Pharmaceuticals, Janssen, and Bristol Myers Squibb, and received research funding from Celgene, Millennium Pharmaceuticals, Novartis, Onyx Pharmaceuticals, AbbVie, Janssen, and Bristol Myers Squibb. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
OS based on FI. (A) OS (years) in nonfrail vs frail patients with newly diagnosed MM. (B) OS in fit vs intermediate-fit vs frail patients with newly diagnosed MM.
Figure 2.
Figure 2.
OS in nonfrail vs frail patients based on ECOG PS. (A-B) OS (years) in nonfrail vs frail patients among those with ECOG PS 0 to 1 (A) and ECOG PS ≥2 (B).
Figure 3.
Figure 3.
Impact of relationship status on OS based on sex. (A-B) OS (years) in patients who are married/in a relationship compared to patients who are not among females (A) and males (B).
Figure 4.
Figure 4.
Changes in frailty status over time. (A-B) Changes in frailty status (nonfrail vs frail) from baseline (T0) to 3 to 6 months (T0 + 3-6 months) (A); and 12 months (T0 + 12 months) after the start of treatment (B).
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