Italian researchers have developed a vulnerability score to better assess survival in multiple myeloma patients. The score is based on the patient’s overall health and the presence of other diseases.

The investigators found that a high vulnerability score was associated with shorter overall survival in all patients, regardless of the patient’s age.

Based on their findings, the investigators recommend that the score be investigated further in larger prospective studies. If its usefulness is confirmed in these studies, the score could be used to personalize treatment for myeloma.

According to the Italian researchers, significant progress has been made with regard to patient outcome since the introduction of the novel agents thalidomide (Thalomid), Velcade (bortezomib), and Revlimid (lenalidomide). However, the researchers point out that improvements have only been modest for older patients.

Many older patients receive lower doses of traditional myeloma treatments due to safety concerns, potentially contributing to the lack of significant improvement in their survival.

The Italian researchers point out that personalized treatment is necessary in myeloma patients, including older patients. They explain that besides conventional prognostic factors such as disease stage and chromosomal abnormalities, patient characteristics such as age, overall health, and the presence of other diseases are currently widely used by physicians to assess a patient’s condition and to develop a treatment plan.

However, according to the Italian researchers, there is currently no objective, uniform tool available to combine these patient characteristics to tailor treatments for patients.

The Italian researchers therefore analyzed data from 266 patients from a regional Italian multiple myeloma registry to determine which patient characteristics may predict survival and to develop a uniform tool based on those factors.

Patient factors the researchers considered included age, overall health, kidney damage, bone lesions or fractures, low blood cell counts, and the presence of other diseases, such as diabetes or heart problems.

The median age of the patients was 73 years; 38 percent were older than 75 years.

Overall, 88 percent of patients received treatment with novel agent-based therapies such as thalidomide (38 percent), Velcade (38 percent), and Revlimid (13 percent), and 30 percent of patients received a transplant.

The median follow-up time was 22 months.

The median three-year overall survival was 74 percent.

The researchers found that disease stage, poor overall health, and the presence of other diseases had a significant impact on survival.

Based on these findings, the researchers developed a tool called a vulnerability score that is based on two patients factors: poor overall health, and the presence of other diseases.

Patients were classified as being in poor overall health if their "performance status," as measured on the WHO/ECOG scale, was either two, three, or four.   Patients falling into this category include those who are bedridden or unable to walk without assistance.  The category also includes, however, patients able to walk on their own, but who are unable to do more than light physical work.

Patients were classified as having other diseases if their Charlson Comorbity Index was one or greater, meaning that they have at least one other reasonably serious disease (such as diabetes, heart disease, or lung disease).

The vulnerability score for a given patient is calculated by assigning one point for each factor the patient has.

For example, a patient who is not in poor overall health and has no other diseases would have a vulnerability score of 0 points.

On the other hand, a patient who is in poor overall health and has other diseases would have a vulnerability score of 2 points.

There are therefore three possible vulnerability scores: low (0 points), intermediate (1 point), and high (2 points).

As expected, the Italian researchers found that patients with a low vulnerability score had the highest three-year median overall survival rate (91 percent), followed by patients with an intermediate score (83 percent), and patients with a high score (36 percent).

The median overall survival times for patients with low and intermediate scores were not yet reached, compared to 27 months for patients with a high score.

The researchers found that the share of patients with a high vulnerability score increased with age: 12 percent of patients aged 65 or younger had a high vulnerability score, compared to 23 percent aged 66 to 75 years, and 35 percent of those older than 75 years.

However, the researchers also found that only a high vulnerability score significantly reduced overall survival in older patients, whereas in younger patients, a high vulnerability score and the disease stage affected overall survival.

For more information, please see the study in Clinical Lymphoma Myeloma and Leukemia (abstract).