Several tools have been proposed for assessing frailty in multiple myeloma (MM), but most are based on clinical trial datasets. There is also limited data on the association between frailty and patient-reported outcomes, and 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 newly diagnosed MM patients. This retrospective study included 515 patients with MM seen at Mayo Clinic (Rochester, MN) at diagnosis between 2005-2018. The FI was calculated using patient-reported data on activities of daily living and comorbidity data, with items scored as 0/0.5/1, where 1 indicated a deficit. The FI was calculated by dividing the total score by the number of non-missing items. Frailty was defined as FI≥0.15; 61% were non-frail and 39% were frail. Frailty and non-married/relationship status were associated with higher disease stage, decreased 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 experience a deterioration in frailty status at 3-12 months, and <10% experience improvement. . In conclusion, a cumulative deficit FI was associated with higher symptom burden and decreased survival in a real-world cohort of MM patients. 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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