P-157: Application of the IMWG Frailty Score in Newly Diagnosed Multiple Myeloma Patients in a Brazilian Cohort

Introduction:
Multiple myeloma (MM) predominantly affects older adults, presenting significant challenges in treatment management due to the heterogeneity in patient health status. Traditionally, chronological age has been a primary factor in determining treatment strategies. However, chronological age alone may not accurately reflect an individual's physiological condition and ability to tolerate and respond to therapy. Frailty scales, which assess a patient's overall health, functional status, and vulnerability to adverse outcomes, have emerged as critical tools in evaluating MM patients. The IMWG frailty score was designed to include four main domains: age, Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADL), and Charlson Comorbidity Index (CCI), and it has been validated in MM patients. The IMWG score categorizes patients into three subgroups: Fit, Unfit, and Frail. This study aims to apply the IMWG score to newly diagnosed MM patients and compare its utility against chronological age.

Methods:
A prospective cohort of newly diagnosed MM patients in a University Hospital was studied. The IMWG frailty score was calculated using the following criteria: age (< 75 years = 0; 75-80 years = 1; >80 years = 2 points), CCI (≤1 = 0; ≥2 = 1 point, with an additional point for each decade above 50 years), ADL ( >4 = 0; ≤4 = 1 point), and IADL ( >5 = 0; ≤5 = 1 point). Patients were categorized as Fit (0 points), Unfit (1 point), or Frail (2 points).

Results:
The cohort included 39 patients with a median age of 66 years (range 36-91). The ISS scores were distributed as follows: 31% scored 1, 31% scored 2, and 38% scored 3. Performance status by ECOG was 0-1 in 18%, 2 in 18%, 3 in 51%, and 4 in 15% of patients. Regarding the IMWG score, 18 (46%) patients had ADL scores >4, and 21 (54%) had ADL scores ≤4. IADL scores ≤5 was observed in 29 (74%) patients, and 90% (n=35) had a CCI ≥2. The IMWG frailty scores categorized patients as Fit (5%), Unfit (39%), and Frail (56%). The most prevalent comorbidities were renal failure (41%), diabetes (20%), and congestive heart failure (10%). Age, as a single parameter, categorizes patients as Frail and Unfit in 5% and 8% since most patients were aged less than 75 years. However, age, as an additional criterion in the ICC, contributed to point 79% of patients as ICC ≥2 (1 point in the final frailty score) and categorized patients as unfit independent of the comorbidities found.

Conclusions:
In this Brazilian cohort of newly diagnosed MM patients treated in a public institution, the IMWG frailty score classified more than half (56%) as frail and around 40% as ISS stage 3. Age is a double-weighted parameter in the score, contributing to the increase in the frail subgroup. The proportion of frail patients doubled the frequency reported from other reported cohorts. These findings indicate a delay in MM diagnosis and suggest a probable impact of socioeconomic status on health outcomes.