RESUMO
Frailty is a hot topic in the field of multiple myeloma (MM). Clinicians have realised that frail myeloma patients can struggle with treatment, resulting in dose reductions and treatment discontinuation, which risk shorter progression-free and overall survival. Efforts have focused on the validity of existing frailty scores and on the development of new indices to identify frail patients more accurately. This review article explores the challenges of the existing frailty scores, including the International Myeloma Working Group (IMWG) frailty score, the revised Myeloma Co-morbidity Index (R-MCI), and the Myeloma Risk Profile (MRP). We conclude that the missing link is for frailty scoring to translate into a tool useful in real-world clinical practice. The future of frailty scores lies in their ability to be woven into clinical trials, to create a robust clinical evidence base for treatment selection and dose modification, and also to identify a cohort of patients who merit additional support from the wider MM multidisciplinary team.
RESUMO
Palpitations are a common presenting symptom in patients attending the emergency department; however, eosinophilic infiltration of the myocardium is rarely the cause. This case describes a 77-year-old woman who presents with sudden onset palpitations and is later diagnosed with eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss syndrome). Cardiac involvement does occur in 50% of cases but heart failure, myocarditis, pericarditis, constrictive pericarditis and myocardial infarction are much more commonly recognised complications. Arrhythmia is less well described. In this report, we propose eosinophilic inflammation as the precipitant for an aberrant conduction pathway.