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Offidani M.,Clinica di Ematologia Clinica di Ematologia Azienda Ospedaliero Universitaria | Corvatta L.,A+ Network | Polloni C.,Clinica di Ematologia Clinica di Ematologia Azienda Ospedaliero Universitaria | Centurioni R.,A+ Network | And 14 more authors.
Clinical Lymphoma, Myeloma and Leukemia | Year: 2012

Background: Multiple myeloma is a typical disease of the elderly but how many and which patients can be considered 'vulnerable' and how this may affect patient outcome remain unsolved issues. Patients and Methods: Data from 266 symptomatic MM patients registered at Marche MM registry from 2007 to 2010 were evaluated retrospectively. Vulnerability was defined as age > 75 years, PS (World Health Organization) < 2, renal insufficiency (RI), bone fracture, cytopenias, and CCI score < 1. Kaplan-Meier method and Cox regression were used to assess survival and associated factors. A vulnerability score (VS) incorporating significant vulnerability features was pursued to predict survival. Results: Thirty-eight percent of patients were older than 75 years, 39% had PS = 2-4, 35% had at least 2 cytopenias, 40% had bone fracture, 14% RI, and 51% had CCI score < 1. Cox regression selected international staging system (ISS) = III (hazard ratio [HR] = 1.6; P =.033), PS = 2-4 (HR = 2.5; P =.007), and CCI = 1-3 (HR = 2.1; P =.028) as factors associated with a worse overall survival. A VS including PS and CCI predicted median survival of 27 months in the 63 patients having a VS = 2 (both PS = 2-4 and CCI = 1-3) versus not reached (NR) in the 203 patients with VS = 0-1 (HR = 4.0; P <.0001). In younger patients multivariate analysis selected ISS = III (HR = 5.2; P =.006) and VS = 2 (HR = 5.5; P =.024) as factors associated with shorter survival whereas only VS = 2 (HR = 3.5; P =.002) affected worse survival in elderly. Conclusion: Such VS proved to be a powerful prognostic factor for survival of MM patients and it might be useful to identify true vulnerable patients regardless of age. © 2012 Elsevier Inc. Source

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