Changes in Frailty Categorization Over One Year among Real-World Patients with Multiple Myeloma: A Prospective Cohort Study (MFRAIL)

BACKGROUND: While the distribution of frailty status in patients with multiple myeloma (MM) has been documented at a single time point, there is limited data examining how frailty changes over time in this population. PATIENTS AND METHODS: Patients aged > 18 years initiating treatment for newly diagnosed or relapsed MM between Aug 2021 and Jul 2023 across 3 sites in Ontario, Canada were enrolled. Frailty assessments were conducted at two time points (baseline and 12-months) using 4 frailty categorization tools: 1) the IMWG frailty index, 2) the Simplified frailty index, 3) the Mayo frailty index, and 4) the Fried frailty phenotype. At baseline and the 12-month follow-up, the frequency and proportion of patients were calculated for both frailty categorization (i.e., non-frail, frail) and continuous frailty scores (i.e., scores 0-5). RESULTS: A total of 116 patients with newly diagnosed or relapsed MM were evaluated for frailty assessments at baseline and after a 12-month follow-up, using 4 different frailty indices. Changes in frailty status across the cohort varied from 13.8% to 37.1%, due to differences in how frailty was defined between each frailty index. In comparison, changes in continuous frailty score across the cohort varied from 20.7% to 51.7%. A total of 17.2% of patients experienced a reduction in gait speed of at least 0.1 m/s. CONCLUSION: This study demonstrates the dynamic nature of frailty highlighting that a one-time baseline frailty measurement may not be adequate. Additionally, continuous frailty scores may be more sensitive to early improvements/deteriorations in frailty that may go undetected using categorical frailty assessments.