The Application of Gait Speed and Grip Strength As a Frailty Screening Tool in Elderly Patients with Hematologic Malignancies

Introduction

Comprehensive geriatric assessments like the International Myeloma Working Group (IMWG-CGA), Lymphoma Italian Foundation (FIL), and Ferrara consensus are used for newly diagnosed MM, DLBCL, and AML patients. However, these assessments are relatively subjective and complex, limiting their widespread use in clinical practice. Gait speed and grip strength are objective measures of physical function that are easy to obtain and take no more time to measure than a typical vital sign. Our analysis aimed to explore the potential value of gait speed and grip strength as screening tests for frailty in elderly patients with blood cancers. Additionally, we sought to examine the significance of dynamic frailty evaluation.

Methods

A total of 120 patients aged 60 years and older, diagnosed with MM, DLBCL, or AML at the Affiliated Hospital of Hebei University between 1 October 2021 and 31 May 2024, were eligible for participation. Gait speed was measured using the National Institutes of Health 4-meter gait speed test. Grip strength was measured using a digital dynamometer, the strength (in kilograms) of the dominant hand was used for this study. Based on the characteristics of different diseases, dynamic evaluations were conducted at various time points during the treatment process. These were compared with the consistency of gait speed, grip strength, and frailty assessment tools. For newly diagnosed elderly patients with MM, dynamic evaluation points were at baseline, C3, and C6. For DLBCL patients, the points were baseline, C4, and C8. For AML patients, evaluations were conducted at baseline, complete remission (CR), and after four courses of treatment.

Results

Our results support the notion that frailty is dynamically changing across the three diseases of MM, DLBCL, and AML, with varying timings and characteristics of frailty improvement. At baseline, MM patients were grouped according to IMWG-CGA into fit (38%), intermediate fit (10%), and frail (52%) categories. At C3 and C6, these groups shifted to fit (48% and 57%), intermediate fit (19% and 17%), and frail (33% and 26%). For DLBCL patients, at baseline, C4, and C8, the groups were fit (58%, 69%, and 78%), unfit (27%, 24%, and 14%), and frail (15%, 7%, and 8%) according to FIL. For AML patients, baseline categorization according to the Ferrara consensus was fit (42%) and unfit (58%). At CR, these proportions were fit (39%) and unfit (61%), and after four courses of treatment, they were fit (57%) and unfit (43%).

Consistency analysis showed that at baseline, gait speed and grip strength had good consistency with IMWG-CGA in MM patients, with AUC values of 0.785 and 0.616, respectively. Further analysis revealed that consistency improved at C3 (AUC = 0.823 and 0.746), and gait speed was equivalent to IMWG-CGA by C6 (AUC = 1.0), followed by grip strength (AUC = 0.857). For DLBCL patients, at baseline, gait speed and grip strength showed consistency with the FIL, with AUC values of 0.815 and 0.774. Dynamic analysis revealed that at C4, the AUC values were 0.708 and 0.689, respectively, and at the end of treatment, the AUC values were 0.772 and 0.806. For AML patients, baseline results showed poor consistency between gait speed and the Ferrara consensus (AUC = 0.65), while grip strength had good consistency (AUC = 0.967). Consistency of gait speed improved at CR and C4, with AUC values of 0.771 and 0.708, while grip strength consistency decreased, with AUC values of 0.854 and 0.642.

Conclusions

This study shows that frailty accounts for a certain proportion in MM, DLBCL, and AML, and the frailty state undergoes dynamic changes with treatment. Our research indicates that gait speed and grip strength are effective and easily obtained frailty screening tools, showing the best consistency with IMWG-CGA and the second-highest consistency with FIL, making them more widely applicable in clinical practice. However, the consistency between gait speed and grip strength with the Ferrara consensus is low, which requires a larger sample sizes and extended follow-up periods for exploration.