b'Intensive Therapy Is Effective TreatmentFor Frail Multiple Myeloma Patients Frailty in cancer patients often has been viewed as a measure of treatment tolerability, including with multiple myeloma, where there is a concern that therapy is likely to be more toxic in patients with higher levels of frailty. A new VA study found, however, that frail veterans had better survival when treated with more-intensivetherapy, although it is not clear that even greater intensity would be of benefit.By LaTina EmersonBOSTONFor frail patients with multiple myelo- Ourstudyfoundthatthemoreintensivetriplet ma, receiving more intensive therapy, triplet bort- bortezomib-lenalidomide-dexamethasone was asso-ezomib-lenalidomide-dexamethasone(VRd)ratherciated with a greater benefit in veterans compared than doublet lenalidomide-dexamethasone (Rd), istothelessintensivedoubletlenalidomide-dexa-amore-effectivetreatment,accordingtoarecentmethasoneconfirmingclinicaltrialevidence, study of patients treated in VA facilities. DuMontier said. This benefit was even more pro-The study published in Blood Advances inves- nounced in veterans with the highest levels of frailty, tigated whether more-intensive therapy could bechallenging the historical expert opinion-based rec-a more effective treatment for frail patients withommendation to consider the doublet over the triplet multiple myeloma. 1 in patients who are frail.The authors are affiliated with VA Boston HealthcareIn general, frailty is viewed as a measure of treat-System and Michael E. DeBakey VAMC in Houston. ment tolerability, whereby the frailer a patient is, the Multiplemyelomaisthesecond-most-commonhigher the risk of toxicity from treatment. The histori-blood cancer, with more than 30,000 new cases diag- cal concern in frail patients is that the risk of toxicity nosed each year. In military veterans, myeloma hasassociated with a more-intensive triplet regimen vs. been linked to Agent Orange exposure, which is rel- a less intensive doublet regimen would outweigh the evant to the aging Vietnam-era population, who makebenefit of better myeloma control, he pointed out.up the growing majority of veterans treated with can- The study found, however, that frail veterans had cer in the VA, Clark DuMontier, MD, a researcher atbetter survival when treated with the triplet therapy VA Boston Healthcare System, told U.S. Medicine. compared to the doublet therapy, contrary to the his-Based on the VA Cancer Registry, there are, on aver- torical recommendation to consider the doublet over age, 800 new cases of multiple myeloma diagnosedthe triplet in this population, DuMontier suggested.in the VA each yearand is likely an underestimate,When looking at the health deficits contributing to DuMontier explained. frailtyinthisveteranpopulation,myeloma-related A study he led examined national VA data that iden- complications (low blood counts, bone disease, kid-tifiedallveteransnewlydiagnosedwithmultipleneydisease)andaggressive(stageIII)myeloma myelomawhoinitiatedtreatmentinVAMCswithweremoreprevalentinpatientswhoweremoder-either the triplet bortezomib-lenalidomide-dexameth- ate-severelyfrailthaninthosewhowerenonfrail, asone (VRd) or the doublet lenalidomide-dexametha- headded,explaining,Moreover,thesemyeloma-sone (Rd) from the years 2004 to 2020. Veterans whorelated deficits were more prevalent in patients who received transplants within the initial months of treat- were frail in the current study than in those in the ment were excluded.more general veteran population. Multiple myeloma 18'