Impact of frailty tools on outcomes in myeloma: MRP and simplified index predict survival but differ in infection risk stratification

To explore the application efficacy of the UK Myeloma Alliance Risk Stratification (MRP) and the Simplified Frailty Index (FI) in patients with newly diagnosed multiple myeloma (NDMM).
205 NDMM patients diagnosed in our hospital from 1 July 2014 to 1 July 2022; frailty was assessed using MRP and Simplified FI. The Fine-Gray competing risk model compared the cumulative incidence of early grade ≥3 infections. Kaplan–Meier method and the log-rank test were applied for analyzing OS and PFS. ROC curves, AUC values, and Youden's index were used to compare the predictive values for OS, PFS, and early grade ≥3 infections. P < 0.05 indicated statistical significance.
The frail groups by MRP and the Simplified FI had significantly shorter OS (36 vs. 75 months and 38 vs. 76 months) and PFS (11 vs. 21 months and 11 vs. 23 months; P < 0.001) with increased mortality risk (HR: 2.51 and 2.12). One-year mortality was significantly higher in frail patients (P < 0.005). The common frail group showed the poorest outcomes, but without significant difference from individual frailty groups (P > 0.05). Frail patients by both showed higher rates of early grade ≥3 infections, but there was no statistically significant difference (50.6% vs. 37.9% and 45.76% vs. 41.78%, P > 0.05). Regarding predictive performance, both tools effectively predicted OS and PFS (all P < 0.05). For early infections, MRP was not predictive (P = 0.237) whereas FI was (P = 0.012), though their predictive performance did not differ significantly (P > 0.05).
Both MRP and FI are effective frailty assessment tools in NDMM patients. They significantly correlate with OS, PFS.