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Clinical impact of frailty on treatment outcomes of elderly patients with relapsed and/or refractory multiple myeloma treated with lenalidomide plus dexamethasone


We compared efficacy and safety, according to frailty, of elderly patients with relapsed and refractory multiple myeloma (RRMM) treated with lenalidomide and dexamethasone (Rd), for whom bortezomib treatment had failed. Patients, 164 (52.9%) and 146 (47.1%), were classified as non-frail and frail using a simplified frailty scale. The overall response rates (ORR) and survival outcomes were lower in frail than in non-frail patients (ORR: 56.2% vs. 67.7%, P = 0.069; median progression free survival: 13.17 vs. 17.80 months, P = 0.033; median overall survival: 23.00 vs. 36.27 months, P = 0.002, respectively). The number of treatment emergent adverse events in grade 3 or worse was higher in frail than in non-frail patients (41.8% vs. 24.4%, P = 0.002, respectively). In frail patients, independent poor prognostic factors for survival were two or more Charlson comorbidity index (CCI) score, prior to exposure to both bortezomib and thalidomide, and achieved less than partial response In conclusion, frailty could predict clinical outcomes of Rd treatment in elderly patients with RRMM who had failed prior bortezomib. In frail patients, lower CCI in addition to less previous treatment exposure and deep response were associated with better survival.

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The authors would like to thank the Korean Multiple Myeloma Working Party and all the researchers and research nurses for their help in data collection and Sangjin Lee who analyzed data statistically. We would like to thank Editage ( for English language editing.

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All authors had access to primary clinical trial data. This study was planned and led by Chang-Ki Min, written by Ho Sup Lee, and analyzed statistically by Sangjin Lee. Patient information was provided by the many investigators of the KMMWP. All authors were involved in manuscript preparation, which was led by Ho Sup Lee and Chang-Ki Min, and all authors approved the final version of the manuscript.

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Correspondence to Chang-Ki Min.

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The authors declare that there are no conflicts of interest. No funding was received for this study.

Ethical approval

According to the Declaration of Helsinki, the trial was approved by the Institutional Research Ethics Board of Kosin University Gospel Hospital, which waived the requirement for informed consent given the retrospective nature of this study (IRB approval number 2020–01-005).

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the Declaration of Helsinki (1964) and its later amendments or comparable ethical standards.

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Lee, H.S., Kim, K., Lee, JJ. et al. Clinical impact of frailty on treatment outcomes of elderly patients with relapsed and/or refractory multiple myeloma treated with lenalidomide plus dexamethasone. Int J Hematol 113, 81–91 (2021).

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  • Elderly multiple myeloma
  • Relapsed and refractory
  • Lenalidomide and dexamethasone
  • Frailty
  • Survival