Treatment of Newly Diagnosed Multiple Myeloma in Patients Not Eligible for Autologous Stem Cell Transplantation with IMWG Frailty Score ≥ 2

Not all patients with newly diagnosed multiple myeloma are candidates for autologous stem cell transplantation. Among those who are not, individuals with an IMWG frailty score of 2 or higher require a treatment approach that accounts for their degree of frailty — both in regimen selection and in how intensively components of that regimen are administered.

Clinical Scenario

This protocol applies to patients with newly diagnosed multiple myeloma who are not eligible for autologous stem cell transplantation and have an IMWG frailty score of 2 or higher. Frailty assessment is central to treatment selection in this setting, guiding both the choice of regimen and decisions about dose intensity for individual components.

Treatment Approach (Partial Overview)

Evidence supports a defined standard-of-care combination regimen for this population, with a recognised strategy to reduce the intensity of one component in patients with higher frailty scores. Alternative combinations are specified for situations where preferred options are unavailable. The complete regimen, sequencing, eligibility criteria, and any dose adjustments are available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/s41571-025-01041-x

DaraRd is currently considered the SOC regimen for the treatment of patients with NDMM and an IMWG FS of ≥2 because the trials testing quadruplet regimens previously described included patients up to the age of 80 years.
A dexamethasone-sparing strategy (DaraR) should be considered in patients with an IMWG FS of ≥2 [I, B].
This approach involves treatment with DaraR and only two cycles of dexamethasone.
If none of the above-mentioned options is available, DaraVMP or VRd can be used [I, A].

View source ↗