The number of older adults with multiple myeloma (MM) will double in the next two decades, yet there is a fundamental gap in knowledge of the impact of baseline geriatric syndromes on treatment selection, toxicity and outcomes in older adults with MM. No MM study to date has included comprehensive geriatric assessments or assessed the impact of therapy on geriatric domains over time. The long-term goals of this project are 1) to integrate geriatric assessments into the care of senior adults with MM so that clinicians may predict toxicity and functional decline due to MM therapy and 2) to facilitate decision-making for clinicians and patients by examining the real-world effectiveness of MM therapy in older adults. The objectives of this project are to compare the prevalence of geriatric syndromes in MM patients who receive high dose therapy/autologous stem cell transplant (HDT/ASCT) versus those who do not, and to identify which patients are vulnerable to decline in functional status. The central hypotheses are that patients with comorbidities or dependence in at least one IADL at baseline will be less likely to undergo intense therapy with HDT/ASCT and that patients with comorbidities will be more likely to develop disability in their IADLs after 6 months of followup. The rationale for the proposed research is that understanding the impact of baseline geriatric factors on treatment decisions and identifying which patients are at risk for functional decline will allow more personalized decision-making and targeted interventions for older MM patients at risk for decline. The objectives will be accomplished through two specific aims: 1) To explore the relationship between baseline geriatric assessments and initial treatment selection in older adults with newly diagnosed multiple myeloma;and 2) To determine whether baseline geriatric syndromes predict decline in functional status at 6 months of follow-up in older adults with newly diagnosed multiple myeloma.
Aim 1 will be accomplished in an prospective pilot cohort study of 30 patients over the age of 65 with recently diagnosed MM seen at Siteman Cancer Center/ Washington University. Patients will complete the Cancer and Aging Research Group geriatric assessment tool;associations between baseline geriatric assessments and initial treatment strategy (HDT/ASCT vs nontransplant) will be evaluated.
For Aim 2, the cohort enrolled in Aim 1 will undergo repeat geriatric assessments at 3 and 6-months of follow-up;risk factors for functional decline will be identified. The contribution of this propsed research is significant because it is the first step in a continuum of research expected to compare the effectiveness of HDT/ASCT to non-transplant treatment strategies both in terms of disease-control and the impact of therapy on quality of survival. The proposed research is innovative because it anticipates an impending paradigm shift wherein cancer is becoming a chronic illness, using MM as a model malignancy to study the interrelationships among geriatric syndromes, treatment selection, long-term toxicities of cancer treatment and survival.
The proposed research is relevant to public health because 10,000 people die of multiple myeloma each year, most of them older adults. While treatment for multiple myeloma can prolong life, the impact of these treatments on functional status and quality of survival is unknown. Thus, the proposed research is relevant to the National Institute of Aging's mission to extend the healthy, active years of life.