The Evolving Role of Frailty Assessment in Systemic Light Chain (AL) Amyloidosis and Multiple Myeloma — Bridging Gaps

Systemic light-chain (AL) amyloidosis and multiple myeloma are two separated but closely related entities. Both are chronic, complex, challenging, heterogeneous, and incurable diseases. Both belong to the broad group of monoclonal gammopathies, with a peak incidence between 60 and 70 years of age. They are characterized by the presence of a bone marrow clonal plasma cell infiltration, and they share similar anti-clonal therapy. Frailty is a dynamic, multidimensional, age-related syndrome, defined by reduced physiological reserve and resistance to stressors, leading to vulnerability and poor outcomes. Therefore, frailty plays a crucial role in clinical decision making to tailor therapy, minimizing toxicity and optimizing outcome. A systematic and comprehensive English PubMed search was undertaken and complemented with other parallel search’ strategies. A growing body of evidence supports including frailty as a standard of care in these diseases, at baseline and dynamically at selected moments through the evolutive course. This narrative review aims to critically analyze the efficiency and prognostic impact of tools and scores used to assess frailty in both clinical scenarios, whether in the context of clinical trials or in real life. Barriers to a widely, dynamic, and standardized use of frailty assessment in the real world are analyzed as well as strategies to overcome them.