Dr. Larocca on the Management of Difficult-to-Treat Patients in Multiple Myeloma

Alessandra Larocca, MD, PhD, hematologist, Division of Hematology, University of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino, Italy, discusses the diagnosis and management of difficult-to-treat patients with multiple myeloma.

Different factors contribute to the prognosis in this patient population, Larocca says. Difficult-to-treat patients may present with high-risk characteristics, such as chromosomal abnormalities, or aggressive disease seen in the form of plasma cell leukemia, extra medullary disease, or an early relapse, Larocca explains. Moreover, patient-related factors, including age, frailty status, comorbidities, functional impairments, and organ function, can impact these patients, Larocca adds.

Patient frailty scores are typically established at diagnosis, and there is no standard assessment for frailty for patients with relapsed/refractory multiple myeloma, Larocca explains. Examining a patient’s comorbidities, functional status, independence, and social support can all play a role in treatment decisions, Larocca explains.

Defining the frailty status of a patient at diagnosis can be helpful at relapse to help provide a more objective measure of a patient’s prognosis, and optimal treatment choices can stem from this information, Larocca concludes.