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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.
摘要：
在多发性骨髓瘤（MM）的老年患者中，平衡治疗疗效和毒性仍然是一个巨大的挑战。主要是由于脆弱的动态性。这里,我们进行了一项前瞻性研究,以评估针对老年患者实施动态弱小治疗(DynaFiT)的可行性和获益.新诊断的MM患者（年龄≥65岁）接受了八个诱导周期的硼替佐米，来那度胺,和地塞米松（daratumumab推荐用于虚弱的患者），根据每个周期的虚弱类别（IMWG-FI）的纵向变化调整治疗强度。90名患者中,33（37%），16（18%），41（45%）是合适的，中间配合,基线脆弱，分别。在75名接受过至少两次老年评估的患者中，28人（37%）经历了至少一次脆弱类别的变化。在分析中，15/26（58％）虚弱的患者有所改善（27％变得健康，31％变得中等健康），4/15（27％）中等健康患者改善或恶化（每个两个），6/30（20％）适合患者恶化。在感应过程中,34/90（38%）患者停止治疗，包括10/33（30％）配合，4/16（25%）中间配合，和20/41（49％）虚弱；14/40（35％）虚弱患者在前两个周期内停止治疗，主要是因为非血液学毒性（主要是感染）。Forfit,中等配合,和虚弱的病人，总反应率为100%,93%,73%,一年总生存率分别为90%，75%,54%,分别。因此,个体化DynaFiT对于异质性老年患者是可行和有希望的。
