Treatment of Newly Diagnosed Multiple Myeloma Not Eligible for Autologous Stem Cell Transplantation — Age Under 80, IMWG Frailty Score Below 2

This protocol addresses newly diagnosed multiple myeloma in patients who cannot proceed to autologous stem cell transplantation (ASCT), are younger than 80 years, and have an IMWG frailty score below 2 — a sub-population distinct from both the frailer transplant-ineligible group and younger fit transplant-eligible patients.

Clinical scenario

Newly diagnosed multiple myeloma
Not eligible for autologous stem cell transplantation
IMWG frailty score < 2
Age < 80 years

For this population, isatuximab- or daratumumab-based combination regimens have emerged as standard-of-care options. The structured protocol specifies which regimens apply, the sequencing between primary and alternative options, and how to proceed when preferred combinations are unavailable — all without modification for age alone.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/s41571-025-01041-x

Patients who are not eligible for ASCT but have an IMWG FS of <2 and are <80 years old can receive two new SOC regimens: IsaVRd and DaraVRd [I, A], although at the time of writing, DaraVRd is pending approval by the EMA.

DaraRd is a valuable option in all transplant-ineligible patients, especially those with an IMWG FS of ≥1 [I, A].

If none of the above-mentioned options is available, DaraVMP or VRd can be used [I, A].

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