DuMontier Discusses Frailty in Newly Diagnosed Multiple Myeloma

Clark DuMontier, MD, geriatrician and clinical researcher at Veterans Affairs Boston Healthcare System and Brigham and Women's Hospital, and assistant professor at Harvard Medical School, discusses the main takeaways from his presentation on treatment intensity and frailty in newly diagnosed patients with multiple myeloma given at the 20th International Myeloma Society Annual Meeting.

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0:10 | For many frail veterans that we see, their myeloma is still their most lethal condition and without treatment, they would die from their myeloma rather than other contributors to their frailty. For frail veterans, especially my population, but frail patients in the community and who value survival and drug regimens that give them a survival benefit, the VRD or the bortezomib [Velcade], lenalidomide [Revlimid], and dexamethasone should be even more prioritized over lenalidomide/dexamethasone rather than the other way around. This is sort of counter to the historical recommendations.

0:52 | Now, this is a non-randomized study. We would benefit more from randomized control trials looking at these treatment comparisons to minimize the potential confounding that exists across these groups. However, I think that now, many older patients, many frail patients are getting sort of triplet regimens with daratumumab. The question is, do other sorts of quadruplet or multi intensive drug regimens still have a better net benefit ratio in frail patients? That's still uncertain. I don't think you can generalize our results to other treatment comparisons. We'll still need more data to determine the best outcomes for those patients.

1:39 | For now, at least, I think the big takeaway is, frailty may not just be a marker of should we dose reduce, or should we pull back on treatment, but rather consideration of whether the disease is actually the main contributor of frailty. For older adults, we've had several who were still active in their community, whatever their age, who will then show up after a new diagnosis suddenly frail, then maybe given that temporality, a lot of their frailty is due to their myeloma and treating the myeloma may actually get them back to what they were doing in the past, which is what we've seen often in practice.