Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

It is known that patients with hematologic malignancy , especially elderly cases, may suffer from other co morbidities that can affect their performance status, tolerability, and response to specific oncology treatment. This issue was examined in many studies. These studies have examined the patient aspect in relation to the type of malignancy and the chemotherapy regimen given to determine the best approach in these situations, not only disease wise but also patient condition. The Cumulative Illness Rating Scale (CIR), appealed as a convenient but comprehensive review of medical problems by organ system, based on a scale of 0 to 4 rating, yielding a cumulative score. This scale was revised to reflect common problems of the elderly with an emphasis on morbidity using specific examples and was renamed the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). So, this work aimed to;(1) summarize the role of proteasome inhibitors in plasma cell neoplasms and the current knowledge on the mechanisms of proteasome inhibitors as antineoplastic agents, and (2) probe the value of using CIRS-G score assessment by CIRS-G calculator web application as a prognostic factor in our Myeloma cases. The study included 30 Egyptian myeloma patients recruited from the adult clinical hematology unit, Kasr Alaini hospital. These included 13 females and 17 males with an age ranging between 36 and 72 years and a median of 57 years. CIRS-G score was assessed before therapy in all cases. They all received at least 3 cycles of bortezomib containing regimens. Thirteen cases (33.4%) presented with a CIRS-G score of < or equal to 6 while 17 cases had a score of >6 (56.6%). Of all our patients, 17 cases (56.6%) showed good response after 3 cycles of Bortezomib containing regimen with 13 CR(43.3%) and 4 PR (13.3%) after 6 cycles. Among cases attaining CR, 7 had a score of <6 in comparison to 6 cases with a high score of 6 or more. On the contrary, the cases not showing any response to treatment were 3 cases and they all had a score of 6 or more. Adverse events were more in high score cases (3 cases) than in low score ones (1 case). However, no statistical significance was noted between any of these subgroups. These data do not indicate undermining therapeutic choice in high CIRS-G score patients

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