ASCO 2026 | Assessing fitness and frailty in patients with MCL: the importance of clinical judgment

It’s the clinical judgment of, you know, discussion with the patient, the patient’s family, what they’re able to do at home. What do you see sitting in front of you? How much is that a disease versus just the patient’s baseline are important characteristics for us. I mean, mantle cell lymphoma as a whole is the disease of older patients. You know, as I get older, you know, elderly, I try to not use that term because again, the average age is 65 plus. And so with improved, you know, supportive care and fitness, you know, what was considered to be unfit before is less unfit now. But I think there’s just a lot of, you know, extra issues that we have to take into consideration when you’re making that consideration for about treatment courses. So while we do have all these geriatric scoring systems, they are very time-consuming and maybe not something that you can conduct during the time of a clinical visit, even within an hour assessment with a new patient because you’re talking about so many different things. To actually then thereafter do a formal assessment sometimes is hard. And again, some of these formal assessments can be biased for the simple fact that some of the detriment to the patient’s physical activity is related to disease. And you don’t necessarily want to hold that against them and necessarily withhold certain treatments because of that. Because again, you would expect some improvement with the treatment course. So with that being said, yes, my sort of assessments have changed. Because again, when I was a younger physician, and obviously you looked at age as a very sort of concrete sort of barrier and then patients above or below without a lot of gray area. As of now, I mean, it’s a very gray area. There’s some 80-year-olds who are quite fit. There’s some 60-year-olds who are quite unfit. And so I think the patient in front of you and sort of what’s contributing to their comorbidities or sort of physical detriment is the most important thing when making the decision about what treatments to offer patients. I will say, though, that some of this may not necessarily be as important as we continue to move away from chemotherapy in patients with mantle cell lymphoma. As we move away or limit the amount of chemotherapy exposure, I think it will open up more of a sort of uniform treatment approach for most patients outside of some of the sort of risk factors that we’re sort of determining impact clinical outcomes.

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