Frailty score analysis of multiple myeloma patients in the evaluation prior to autologous hematopoietic stem cell transplantation

Authors

  • Felipe de Menezes Cunha Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0009-0001-3841-0289
  • Hércules Amorim Mota Segundo Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0009-0000-1494-078X
  • Livia Andrade Gurgel Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0002-9231-268X
  • Lucas Freire Castelo Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0002-6618-6632
  • Natalia Costa Bezerra Freire Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0003-3017-5357
  • João Paulo de Vasconcelos Leitão Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0003-1715-034X
  • Beatriz Stela Gomes de Souza Pitombeira Araujo Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0002-9648-506X
  • Karine Sampaio Nunes Barroso Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0002-5346-9414
  • Gustavo Mesquita de Oliveira Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0002-6059-9145
  • Maria Laura Fontoura Chagas Rocha Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0009-0009-0927-9101
  • Emanuelly Thays Muniz Figueiredo Silva Vasconcelos Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0001-6204-6299
  • Fernando Barroso Duarte Universidade Federal do Ceará – Faculdade de Medicina – Departamento de Hematologia e Hemoterapia – Fortaleza (CE), Brazil. https://orcid.org/0000-0001-5170-695X

DOI:

https://doi.org/10.46765/2675-374X.2025v7n1e316

Keywords:

Multiple Myeloma, Frailty, Hematopoietic stem cell transplantation

Abstract

Introduction: Multiple myeloma (MM) is a common hematological neoplasm that is more prevalent at older ages. Autologous stem cell transplantation (ASCT) remains a relevant treatment option. The International Myeloma Working Group (IMWG) developed a score to assess frailty, dividing patients into fit, intermediate-fit, and frail. This study aims to analyze the profile, using the IMWG frailty score, of MM patients evaluated for ASCT. Methods: Retrospective, with a prospective arm, observational, descriptive study based on the review of records of MM patients evaluated for ASCT using the IMWG score in a Brazilian hospital from 2023 to 2025. Results: Eighty-one patients composed the sample, with a median age of 59 years. Using the IMWG frailty score, 57% of patients were classified as fit, 34% as intermediate-fit, and 9% as frail. Scoring on the IMWG score was decisive to contraindicating transplant (statistically significant difference compared to the fit group). There were no significant differences between groups concerning the toxicities, with a trend toward an increased risk of febrile neutropenia among frail patients (p = 0.058). The proportion of patients aged over 60 years was similar across groups. Conclusion: The IMWG frailty score is a valuable tool and reinforces the necessity of considering variables beyond age. Further discussion is required to validate these findings in diverse populations.

References

1. O’Donnel EK, Bianchi G, Anderson K. Myeloma. In: Kaushansky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ, editors. Williams hematology. 10th ed. New York: McGraw Hill; 2021. p. 1831-71.

2. Rajkumar SV. Multiple myeloma: 2024 update on diagnosis, risk stratification, and management. Am J Hematol. 2024;99(9):1802-24. https://doi.org/10.1002/ajh.27422

3. Brazil. Ministério da Saúde. DATASUS: Departamento de Informática do SUS. Brasília: Ministério da Saúde; 2025 [cited 2025 Jan 11]. Available from: http://tabnet.datasus.gov.br/cgi/dhdat.exe?PAINEL_ONCO/PAINEL_ONCOLOGIABR.def

4. Perrot A. Transplant in myeloma: who, when, and why? Hematology Am Soc Hematol Educ Program. 2024;2024(1):561-8. https://doi.org/10.1182/hematology.2024000580

5. Beksac M, Hayden P. Upfront autologous transplantation still improving outcomes in patients with multiple myeloma. Lancet Haematol. 2023; 10(2): e80-e82. https://doi.org/10.1016/S2352-3026(22)00360-X

6. Morè S, Corvatta L, Manieri V, Saraceni F, Scortechini I, Mancini G, et al. Autologous stem cell transplantation in multiple myeloma: where are we and where do we want to go? Cells. 2022;11(4):606. https://doi.org/10.3390/cells11040606

7. Waszczuk-Gajda A, Penack O, Sbianchi G, Koster L, Blaise D, Reményi P, et al. Complications of autologous stem cell transplantation in multiple myeloma: results from the CALM study. J Clin Med. 2022;11(12):3541. https://doi.org/10.3390/jcm11123541

8. Mian H, McCurdy A, Giri S, Grant S, Rochwerg B, Winks E, et al. The prevalence and outcomes of frail older adults in clinical trials in multiple myeloma: a systematic review. Blood Cancer J. 2023;13(1):1-13. https://doi.org/10.1038/s41408-022-00779-2

9. Miller HL, Sharpley FA. Frail multiple myeloma patients deserve more than just a score. Hematol Rep. 2023;15(1):151-6. https://doi.org/10.3390/hematolrep15010015

10. Möller MD, Gengenbach L, Graziani G, Greil C, Wäsch R, Engelhardt M. Geriatric assessments and frailty scores in multiple myeloma patients: a needed tool for individualized treatment? Curr Opin Oncol. 2021;33(6):648-57. https://doi.org/10.1097/CCO.0000000000000792

11. Sim S, Kalff A, Tuch G, Mollee P, Ho PJ, Harrison S, et al. The importance of frailty assessment in multiple myeloma: a position statement from the Myeloma Scientific Advisory Group to Myeloma Australia. Intern Med J. 2023;53(5):819-24. https://doi.org/10.1111/imj.16049

12. Ortiz CR, Beauverd Y, Samii K. Assessment and treatment of elderly patients with multiple myeloma. Healthbook TIMES Oncol Hematol. 2024;(20):1-15.

13. Engelhardt M, Dold SM, Ihorst G, Zober A, Moller M, Reinhardt H, et al. Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores. Haematologica. 2016;101(9):1110-9. https://doi.org/10.3324/haematol.2016.148189

14. Palumbo A, Bringhen S, Mateos MV, Larocca A, Facon T, Kumar SK, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 2015;125(13):2068-74.

15. Belotti A, Ribolla R, Cancelli V, Bianchetti N, Crippa C, Ferrari S, et al. Transplant eligibility in elderly multiple myeloma patients: prospective external validation of the International Myeloma Working Group frailty score and comparison with clinical judgment and other comorbidity scores in unselected patients aged 65-75 years. Am J Hematol. 2020;95(7):759-65. https://doi.org/10.1002/ajh.25797

16. Wu X, Fu C, Shen H, You H, Zhai Y, Wang J, et al. IMWG/ECOG frailty score was a good indicator for ASCT candidate selection for NDMM in China from a HCMMd retrospective study. Blood. 2023; 142 (Suppl 1): 7061. https://doi.org/10.1182/blood-2023-185763

17. Devasia AJ, Khan S, Atenafu E, Vohra H, Larose F, Reece D, et al. Selected frailty testing can predict for risk of febrile neutropenia in multiple myeloma patients undergoing autologous stem cell transplant. Blood. 2023;142(Suppl 1):1997. https://doi.org/10.1182/blood-2023-190310

Downloads

Published

05/19/2026

How to Cite

Cunha, F. de M., Mota Segundo, H. A., Gurgel, L. A., Castelo, L. F., Freire, N. C. B., Leitão, J. P. de V., … Duarte, F. B. (2026). Frailty score analysis of multiple myeloma patients in the evaluation prior to autologous hematopoietic stem cell transplantation. JOURNAL OF BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY, 7(1). https://doi.org/10.46765/2675-374X.2025v7n1e316

Issue

Vol. 7 No. 1 (2026): Journal of Bone Marrow Transplantation and Cellular Therapy

Section

Original article

License

Copyright (c) 2026 Felipe de Menezes Cunha, Hércules Amorim Mota Segundo, Livia Andrade Gurgel, Lucas Freire Castelo, Natalia Costa Bezerra Freire, João Paulo de Vasconcelos Leitão, Beatriz Stela Gomes de Souza Pitombeira Araujo, Karine Sampaio Nunes Barroso, Gustavo Mesquita de Oliveira, Maria Laura Fontoura Chagas Rocha, Emanuelly Thays Muniz Figueiredo Silva Vasconcelos, Fernando Barroso Duarte

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.