What is a second primary malignancy (SPM) and what is a myeloma patient’s risk for developing one while on Revlimid maintenance therapy?
SPM is another cancer that occurs after the diagnosis of multiple myeloma. Myeloma patients may be at risk of developing a SPM with long-term use of Revlimid such as its use as maintenance therapy (which is a standard of care for newly diagnosed patients). A recent clinical study (called the Myeloma XI study) showed the impact of Revlimid (as induction and maintenance) on the development of SPM, since Revlimid was used in both transplant-eligible and -ineligible newly diagnosed patients. The results of the study showed that patients who received Revlimid as induction and maintenance (double-exposure) had a higher incidence of SPMs; this observation was more marked in transplant-ineligible patients. And although deaths due to SPMs were increased with Revlimid maintenance, deaths due to myeloma were lower. Therefore, patients should be carefully monitored while receiving Revlimid maintenance so that possible early intervention for SPMs can occur.
What is a frailty score for patients with myeloma and what does this score measure?
In addition to age, a variety of factors influence fitness and frailty in older patients with MM. For example, older MM patients can have multiple comorbidities and a range of activity levels that affect their response to, adherence to, and tolerance of MM treatment approaches. Therefore, treatment decisions for every patient should consider not only age but also clinical and functional status. Physicians use a frailty score assessment that is designed to help predict prognosis of patients with MM and help guide them on what therapy to offer. The link here (www.myelomafrailtyscorecalculator.net/) shows the different categories that are used to calculate a frailty score specific for myeloma patients. It evaluates comorbidities and how functional a patient is to determine how frail a patient is. It is important to note that frailty can improve or decline with time, so continuous assessment of patient fitness is important to providing the best possible care.