{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:11:54Z","timestamp":1778803914960,"version":"3.51.4"},"reference-count":78,"publisher":"Harborside Press, LLC","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>Older patients with multiple myeloma (MM) exhibit wide heterogeneity in their baseline physiologic and functional status, which demands an individualized treatment approach based on biological rather than chronological age. Various frailty scores have been developed for older patients with MM, but they are underutilized in clinical trials and in practice. Older patients with MM are underrepresented in therapeutic clinical trials, and treatment recommendations are currently derived from clinical trials of transplant-ineligible patients. This article provides a summary of phase II and III clinical trials in transplant-ineligible patients with newly diagnosed MM, highlighting outcomes in patients aged \u226575 years and frailty-based outcomes. The data available thus far show that triplet regimens are more efficacious than doublets in older patients but may be associated with higher toxicity. DRd (daratumumab\/lenalidomide\/dexamethasone) and VRd (bortezomib\/lenalidomide\/dexamethasone) are good options in patients who are nonfrail, whereas dose-adjusted DRd and VRd-lite should be offered to frail patients. Frailty should be assessed regularly to guide treatment intensification and\/or deescalation. It is important that frailty measures are incorporated in clinical trials evaluating novel treatments to inform how older and frail patients will benefit from these treatments.<\/jats:p>","DOI":"10.6004\/jnccn.2024.7039","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T13:34:24Z","timestamp":1731504864000},"source":"Crossref","is-referenced-by-count":5,"title":["Up-Front Treatment of Elderly (Age \u226575 Years) and Frail Patients With Multiple Myeloma"],"prefix":"10.6004","volume":"22","author":[{"given":"Nadine","family":"Abdallah","sequence":"first","affiliation":[{"name":"Division of Hematology, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaji K.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Hematology, Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"B1","article-title":"Cancer Stat Facts: Myeloma","author":"National Cancer Institute","unstructured":"National Cancer Institute. 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Blood 2015;125:2068\u20132074."},{"key":"B11","series-title":"J Gerontol A Biol Sci Med Sci","first-page":"255","article-title":"Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care","volume":"59","author":"Fried LP","year":"2004","unstructured":"Fried LP, Ferrucci L, Darer J,  Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255\u2013263."},{"key":"B12","series-title":"Haematologica","first-page":"910","article-title":"A concise revised Myeloma Comorbidity Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients","volume":"102","author":"Engelhardt M","year":"2017","unstructured":"Engelhardt M, Domm AS, Dold SM,  A concise revised Myeloma Comorbidity Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients. Haematologica 2017;102:910\u2013921."},{"key":"B13","series-title":"Haematologica","first-page":"875","article-title":"Validation of the revised myeloma comorbidity index and other comorbidity scores in a multicenter German study group multiple myeloma trial","volume":"106","author":"Sandra Maria D","year":"2020","unstructured":"Sandra Maria D, Mandy-Deborah M, Gabriele I,  Validation of the revised myeloma comorbidity index and other comorbidity scores in a multicenter German study group multiple myeloma trial. Haematologica 2020;106:875\u2013880."},{"key":"B14","series-title":"Lancet Haematol","first-page":"e154","article-title":"A clinical prediction model for outcome and therapy delivery in transplant-ineligible patients with myeloma (UK Myeloma Research Alliance Risk Profile): a development and validation study","volume":"6","author":"Cook G","year":"2019","unstructured":"Cook G, Royle KL, Pawlyn C,  A clinical prediction model for outcome and therapy delivery in transplant-ineligible patients with myeloma (UK Myeloma Research Alliance Risk Profile): a development and validation study. Lancet Haematol 2019;6:e154\u2013166."},{"key":"B15","series-title":"Am J Hematol","first-page":"1129","article-title":"N-terminal fragment of the type-B natriuretic peptide (NT-proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma","volume":"91","author":"Milani P","year":"2016","unstructured":"Milani P, Vincent Rajkumar S, Merlini G,  N-terminal fragment of the type-B natriuretic peptide (NT-proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma. Am J Hematol 2016;91:1129\u20131134."},{"key":"B16","series-title":"Leukemia","first-page":"224","article-title":"A simplified frailty scale predicts outcomes in transplant-ineligible patients with newly diagnosed multiple myeloma treated in the FIRST (MM-020) trial","volume":"34","author":"Facon T","year":"2020","unstructured":"Facon T, Dimopoulos MA, Meuleman N,  A simplified frailty scale predicts outcomes in transplant-ineligible patients with newly diagnosed multiple myeloma treated in the FIRST (MM-020) trial. Leukemia 2020;34:224\u2013233."},{"key":"B17","series-title":"Leukemia","first-page":"1964","article-title":"Validation of the FIRST simplified frailty scale using the ECOG performance status instead of patient-reported activities","volume":"34","author":"Stege CAM","year":"2020","unstructured":"Stege CAM, van der Holt B, Dinmohamed AG,  Validation of the FIRST simplified frailty scale using the ECOG performance status instead of patient-reported activities. Leukemia 2020;34:1964\u20131966."},{"key":"B18","series-title":"Lancet","first-page":"825","article-title":"Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial","volume":"367","author":"Palumbo A","year":"2006","unstructured":"Palumbo A, Bringhen S, Caravita T,  Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006;367:825\u2013831."},{"key":"B19","series-title":"Blood","first-page":"3107","article-title":"Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized controlled trial","volume":"112","author":"Palumbo A","year":"2008","unstructured":"Palumbo A, Bringhen S, Liberati AM,  Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized controlled trial. Blood 2008;112:3107\u20133114."},{"key":"B20","series-title":"J Clin Oncol","first-page":"3664","article-title":"Efficacy of melphalan and prednisone plus thalidomide in patients older than 75 years with newly diagnosed multiple myeloma: IFM 01\/01 trial","volume":"27","author":"Hulin C","year":"2009","unstructured":"Hulin C, Facon T, Rodon P,  Efficacy of melphalan and prednisone plus thalidomide in patients older than 75 years with newly diagnosed multiple myeloma: IFM 01\/01 trial. J Clin Oncol 2009;27:3664\u20133670."},{"key":"B21","series-title":"N Engl J Med","first-page":"1759","article-title":"Continuous lenalidomide treatment for newly diagnosed multiple myeloma","volume":"366","author":"Palumbo A","year":"2012","unstructured":"Palumbo A, Hajek R, Delforge M,  Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 2012;366:1759\u20131769."},{"key":"B22","series-title":"Blood","first-page":"1109","article-title":"Melphalan, prednisone, and lenalidomide versus melphalan, prednisone, and thalidomide in untreated multiple myeloma","volume":"127","author":"Zweegman S","year":"2016","unstructured":"Zweegman S, van der Holt B, Mellqvist UH,  Melphalan, prednisone, and lenalidomide versus melphalan, prednisone, and thalidomide in untreated multiple myeloma. Blood 2016;127:1109\u20131116."},{"key":"B23","series-title":"Blood","first-page":"1953","article-title":"Carfilzomib or bortezomib with melphalan-prednisone for transplant-ineligible patients with newly diagnosed multiple myeloma","volume":"133","author":"Facon T","year":"2019","unstructured":"Facon T, Lee JH, Moreau P,  Carfilzomib or bortezomib with melphalan-prednisone for transplant-ineligible patients with newly diagnosed multiple myeloma. Blood 2019;133:1953\u20131963."},{"key":"B24","series-title":"Blood","first-page":"1231","article-title":"Cyclophosphamide, thalidomide, and dexamethasone (CTD) as initial therapy for patients with multiple myeloma unsuitable for autologous transplantation","volume":"118","author":"Morgan GJ","year":"2011","unstructured":"Morgan GJ, Davies FE, Gregory WM,  Cyclophosphamide, thalidomide, and dexamethasone (CTD) as initial therapy for patients with multiple myeloma unsuitable for autologous transplantation. Blood 2011;118:1231\u20131238."},{"key":"B25","series-title":"Blood","first-page":"63","article-title":"Carfilzomib, cyclophosphamide, and dexamethasone in patients with newly diagnosed multiple myeloma: a multicenter, phase 2 study","volume":"124","author":"Bringhen S","year":"2014","unstructured":"Bringhen S, Petrucci MT, Larocca A,  Carfilzomib, cyclophosphamide, and dexamethasone in patients with newly diagnosed multiple myeloma: a multicenter, phase 2 study. Blood 2014;124:63\u201369."},{"key":"B26","series-title":"Eur J Cancer","first-page":"89","article-title":"All-oral ixazomib, cyclophosphamide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma","volume":"106","author":"Dimopoulos MA","year":"2019","unstructured":"Dimopoulos MA, Grosicki S, J\u0119drzejczak WW,  All-oral ixazomib, cyclophosphamide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma. Eur J Cancer 2019;106:89\u201398."},{"key":"B27","series-title":"N Engl J Med","first-page":"906","article-title":"Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma","volume":"371","author":"Benboubker L","year":"2014","unstructured":"Benboubker L, Dimopoulos MA, Dispenzieri A,  Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 2014;371:906\u2013917."},{"key":"B28","series-title":"Blood","first-page":"301","article-title":"Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma","volume":"131","author":"Facon T","year":"2018","unstructured":"Facon T, Dimopoulos MA, Dispenzieri A,  Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma. Blood 2018;131:301\u2013310."},{"key":"B29","series-title":"Blood","first-page":"1102","article-title":"Triplet vs doublet lenalidomide-containing regimens for the treatment of elderly patients with newly diagnosed multiple myeloma","volume":"127","author":"Magarotto V","year":"2016","unstructured":"Magarotto V, Bringhen S, Offidani M,  Triplet vs doublet lenalidomide-containing regimens for the treatment of elderly patients with newly diagnosed multiple myeloma. Blood 2016;127:1102\u20131108."},{"key":"B30","series-title":"Haematologica","first-page":"1937","article-title":"Lenalidomide-based induction and maintenance in elderly newly diagnosed multiple myeloma patients: updated results of the EMN01 randomized trial","volume":"105","author":"Bringhen S","year":"2020","unstructured":"Bringhen S, D\u2019Agostino M, Paris L,  Lenalidomide-based induction and maintenance in elderly newly diagnosed multiple myeloma patients: updated results of the EMN01 randomized trial. Haematologica 2020;105:1937\u20131947."},{"key":"B31","series-title":"Lancet","first-page":"519","article-title":"Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial","volume":"389","author":"Durie BGM","year":"2017","unstructured":"Durie BGM, Hoering A, Abidi MH,  Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017;389:519\u2013527."},{"key":"B32","series-title":"Blood Cancer J","first-page":"53","article-title":"Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT)","volume":"10","author":"Durie BGM","year":"2020","unstructured":"Durie BGM, Hoering A, Sexton R,  Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT). Blood Cancer J 2020;10:53."},{"key":"B33","series-title":"Lancet Oncol","first-page":"1317","article-title":"Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): a multicentre, open-label, phase 3, randomised, controlled trial","volume":"21","author":"Kumar SK","year":"2020","unstructured":"Kumar SK, Jacobus SJ, Cohen AD,  Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol 2020;21:1317\u20131330."},{"key":"B34","series-title":"Blood","first-page":"3616","article-title":"Oral ixazomib, lenalidomide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma","volume":"137","author":"Facon T","year":"2021","unstructured":"Facon T, Venner CP, Bahlis NJ,  Oral ixazomib, lenalidomide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma. Blood 2021;137:3616\u20133628."},{"key":"B35","series-title":"Lancet","first-page":"132","article-title":"Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (ALCYONE): a randomised, open-label, phase 3 trial","volume":"395","author":"Mateos MV","year":"2020","unstructured":"Mateos MV, Cavo M, Blade J,  Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (ALCYONE): a randomised, open-label, phase 3 trial. Lancet 2020;395:132\u2013141."},{"key":"B36","series-title":"N Engl J Med","first-page":"518","article-title":"Daratumumab plus bortezomib, melphalan, and prednisone for untreated myeloma","volume":"378","author":"Mateos MV","year":"2018","unstructured":"Mateos MV, Dimopoulos MA, Cavo M,  Daratumumab plus bortezomib, melphalan, and prednisone for untreated myeloma. N Engl J Med 2018;378:518\u2013528."},{"key":"B37","article-title":"Overall survival results with daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: phase 3 MAIA study. Presented at the EHA2021 Virtual Congress","author":"Facon T","unstructured":"Facon T, Kumar SK, Plesner T,  Overall survival results with daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: phase 3 MAIA study. Presented at the EHA2021 Virtual Congress; June 9\u201317, 2021. Abstract LB1901."},{"key":"B38","series-title":"N Engl J Med","first-page":"2104","article-title":"Daratumumab plus lenalidomide and dexamethasone for untreated myeloma","volume":"380","author":"Facon T","year":"2019","unstructured":"Facon T, Kumar S, Plesner T,  Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med 2019;380:2104\u20132115."},{"key":"B39","series-title":"Blood","first-page":"492","article-title":"Sustained minimal residual disease negativity in newly diagnosed multiple myeloma and the impact of daratumumab in MAIA and ALCYONE","volume":"139","author":"San-Miguel J","year":"2022","unstructured":"San-Miguel J, Avet-Loiseau H, Paiva B,  Sustained minimal residual disease negativity in newly diagnosed multiple myeloma and the impact of daratumumab in MAIA and ALCYONE. Blood 2022;139:492\u2013501."},{"key":"B40","series-title":"J Clin Oncol","first-page":"8004","article-title":"Daratumumab (DARA) maintenance or observation (OBS) after treatment with bortezomib, thalidomide and dexamethasone (VTd) with or without DARA and autologous stem cell transplant (ASCT) in patients (pts) with newly diagnosed multiple myeloma (NDMM): CASSIOPEIA Part 2","volume":"39","author":"Moreau P","year":"2021","unstructured":"Moreau P, Sonneveld P. Daratumumab (DARA) maintenance or observation (OBS) after treatment with bortezomib, thalidomide and dexamethasone (VTd) with or without DARA and autologous stem cell transplant (ASCT) in patients (pts) with newly diagnosed multiple myeloma (NDMM): CASSIOPEIA Part 2. J Clin Oncol 2021;39(Suppl):Abstract 8004."},{"key":"B41","series-title":"BMC Cancer","first-page":"1087","article-title":"Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma","volume":"20","author":"Fonseca R","year":"2020","unstructured":"Fonseca R, Usmani SZ, Mehra M,  Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma. BMC Cancer 2020;20:1087."},{"key":"B42","series-title":"J Clin Oncol","first-page":"TPS8056","article-title":"Bortezomib, lenalidomide, and dexamethasone (VRd) \u00b1 daratumumab (DARA) in patients (pts) with newly diagnosed multiple myeloma (NDMM) for whom transplant is not planned as initial therapy: a multicenter, randomized, phase III study (CEPHEUS)","volume":"37","author":"Zweegman S","year":"2019","unstructured":"Zweegman S, Usmani SZ, Chastain K,  Bortezomib, lenalidomide, and dexamethasone (VRd) \u00b1 daratumumab (DARA) in patients (pts) with newly diagnosed multiple myeloma (NDMM) for whom transplant is not planned as initial therapy: a multicenter, randomized, phase III study (CEPHEUS). J Clin Oncol 2019;37(Suppl):Abstract TPS8056."},{"key":"B43","series-title":"Br J Haematol","first-page":"222","article-title":"A phase 2 study of modified lenalidomide, bortezomib and dexamethasone in transplant-ineligible multiple myeloma","volume":"182","author":"O\u2019Donnell EK","year":"2018","unstructured":"O\u2019Donnell EK, Laubach JP, Yee AJ,  A phase 2 study of modified lenalidomide, bortezomib and dexamethasone in transplant-ineligible multiple myeloma. Br J Haematol 2018;182:222\u2013230."},{"key":"B44","series-title":"Blood","first-page":"3178","article-title":"Updated results of a phase 2 study of modified lenalidomide, bortezomib, and dexamethasone (RVd-lite) in transplant-ineligible multiple myeloma","volume":"134","author":"O\u2019Donnell EK","year":"2019","unstructured":"O\u2019Donnell EK, Laubach JP, Yee AJ,  Updated results of a phase 2 study of modified lenalidomide, bortezomib, and dexamethasone (RVd-lite) in transplant-ineligible multiple myeloma. Blood 2019;134(Suppl 1):3178."},{"key":"B45","series-title":"Blood","first-page":"305","article-title":"Efficacy and feasibility of dose\/schedule-adjusted Rd-R Vs. continuous Rd in elderly and intermediate-fit newly diagnosed multiple myeloma (NDMM) patients: RV-MM-PI-0752 phase III randomized study","volume":"132","author":"Larocca A","year":"2018","unstructured":"Larocca A, Salvini M, De Paoli L,  Efficacy and feasibility of dose\/schedule-adjusted Rd-R Vs. continuous Rd in elderly and intermediate-fit newly diagnosed multiple myeloma (NDMM) patients: RV-MM-PI-0752 phase III randomized study. Blood 2018;132(Suppl 1):305."},{"key":"B46","series-title":"Blood","first-page":"3027","article-title":"Dose\/schedule-adjusted Rd-R vs continuous Rd for elderly, intermediate-fit patients with newly diagnosed multiple myeloma","volume":"137","author":"Larocca A","year":"2021","unstructured":"Larocca A, Bonello F, Gaidano G,  Dose\/schedule-adjusted Rd-R vs continuous Rd for elderly, intermediate-fit patients with newly diagnosed multiple myeloma. Blood 2021;137:3027\u20133036."},{"key":"B47","series-title":"Blood","first-page":"3381","article-title":"Replacing steroids in transplant-ineligible multiple myeloma: the phase 2 isatuximab-bortezomib-lenalidomide-dexamethasone rest study","volume":"142","author":"Askeland FB","year":"2023","unstructured":"Askeland FB, Hauk\u00e5s E, Sl\u00f8rdahl TS,  Replacing steroids in transplant-ineligible multiple myeloma: the phase 2 isatuximab-bortezomib-lenalidomide-dexamethasone rest study. Blood 2023;142(Suppl 1):3381."},{"key":"B48","series-title":"Blood","first-page":"1369","article-title":"A dexamethasone sparing-regimen with daratumumab and lenalidomide in frail patients with newly-diagnosed multiple myeloma: efficacy and safety analysis of the phase 3 IFM2017-03 trial","volume":"140","author":"Manier S","year":"2022","unstructured":"Manier S, Corre J, Hulin C,  A dexamethasone sparing-regimen with daratumumab and lenalidomide in frail patients with newly-diagnosed multiple myeloma: efficacy and safety analysis of the phase 3 IFM2017-03 trial. Blood 2022;140(Suppl 1):1369\u20131370."},{"key":"B49","series-title":"J Clin Oncol","first-page":"2758","article-title":"Ixazomib, daratumumab, and low-dose dexamethasone in frail patients with newly diagnosed multiple myeloma: the Hovon 143 study","volume":"39","author":"Stege CAM","year":"2021","unstructured":"Stege CAM, Nasserinejad K, van der Spek E,  Ixazomib, daratumumab, and low-dose dexamethasone in frail patients with newly diagnosed multiple myeloma: the Hovon 143 study. J Clin Oncol 2021;39:2758\u20132767."},{"key":"B50","series-title":"Blood","first-page":"4239","article-title":"A frailty scale predicts outcomes of patients with newly diagnosed multiple myeloma who are ineligible for transplant treated with continuous lenalidomide plus low-dose dexamethasone on the first trial","volume":"126","author":"Facon T","year":"2015","unstructured":"Facon T, Hulin C, Dimopoulos MA,  A frailty scale predicts outcomes of patients with newly diagnosed multiple myeloma who are ineligible for transplant treated with continuous lenalidomide plus low-dose dexamethasone on the first trial. Blood 2015;126(Suppl 1):4239."},{"key":"B51","series-title":"Clin Lymphoma Myeloma Leuk","first-page":"785","article-title":"Daratumumab plus bortezomib, melphalan, and prednisone versus bortezomib, melphalan, and prednisone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of ALCYONE","volume":"21","author":"Mateos MV","year":"2021","unstructured":"Mateos MV, Dimopoulos MA, Cavo M,  Daratumumab plus bortezomib, melphalan, and prednisone versus bortezomib, melphalan, and prednisone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of ALCYONE. Clin Lymphoma Myeloma Leuk 2021;21:785\u2013798."},{"key":"B52","series-title":"Leukemia","first-page":"1066","article-title":"Daratumumab plus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of MAIA","volume":"36","author":"Facon T","year":"2022","unstructured":"Facon T, Cook G, Usmani SZ,  Daratumumab plus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of MAIA. Leukemia 2022;36:1066\u20131077."},{"key":"B53","series-title":"Blood","first-page":"205","article-title":"Carfilzomib-lenalidomide- dexamethasone (KRd) vs. lenalidomide-dexamethasone (Rd) in newly diagnosed fit or intermediate-fit multiple myeloma patients not eligible for autologous stem-cell transplantation (phase III EMN20 trial): analysis of sustained undetectable minimal residual disease (MRD)","volume":"142","author":"Bringhen S","year":"2023","unstructured":"Bringhen S, Antonioli E, Gamberi B,  Carfilzomib-lenalidomide- dexamethasone (KRd) vs. lenalidomide-dexamethasone (Rd) in newly diagnosed fit or intermediate-fit multiple myeloma patients not eligible for autologous stem-cell transplantation (phase III EMN20 trial): analysis of sustained undetectable minimal residual disease (MRD). Blood 2023;142(Suppl 1):205."},{"key":"B54","unstructured":"Compare lenalidomide and subcutaneous daratumumab vs lenalidomide and dexamethasone in frail subjects with previously untreated multiple myeloma who are ineligible for high dose therapy (IFM2017_03). Accessed July 27, 2023. 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J Clin Oncol 2018;36(Suppl): Abstract TPS8055."},{"key":"B63","series-title":"Lancet Haematol","first-page":"e403","article-title":"Addition of elotuzumab to lenalidomide and dexamethasone for patients with newly diagnosed, transplantation ineligible multiple myeloma (ELOQUENT-1): an open- label, multicentre, randomised, phase 3 trial","volume":"9","author":"Dimopoulos MA","year":"2022","unstructured":"Dimopoulos MA, Richardson PG, Bahlis NJ,  Addition of elotuzumab to lenalidomide and dexamethasone for patients with newly diagnosed, transplantation ineligible multiple myeloma (ELOQUENT-1): an open- label, multicentre, randomised, phase 3 trial. 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Leukemia 2020;34:224\u2013233."},{"key":"B70","series-title":"Blood Cancer J","first-page":"e35","article-title":"Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM-comorbidity score","volume":"1","author":"Kleber M","year":"2011","unstructured":"Kleber M, Ihorst G, Terhorst M,  Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM-comorbidity score. 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Blood 2018;132:800."},{"key":"B75","series-title":"Blood","first-page":"3305","article-title":"Feasibility and efficacy of dose adjusted melphalan - prednisone - bortezomib (MPV) in elderly patients \u2265 75 years of age with newly diagnosed multiple myeloma; the non-randomised phase II HOVON 123 study","volume":"128","author":"Zweegman S","year":"2016","unstructured":"Zweegman S, Levin MD, Klein SK,  Feasibility and efficacy of dose adjusted melphalan - prednisone - bortezomib (MPV) in elderly patients \u2265 75 years of age with newly diagnosed multiple myeloma; the non-randomised phase II HOVON 123 study. 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Blood 2018;132:1889."},{"key":"B77","series-title":"Leukemia","first-page":"1320","article-title":"A phase 2 study of three low-dose intensity subcutaneous bortezomib regimens in elderly frail patients with untreated multiple myeloma","volume":"30","author":"Larocca A","year":"2016","unstructured":"Larocca A, Bringhen S, Petrucci MT,  A phase 2 study of three low-dose intensity subcutaneous bortezomib regimens in elderly frail patients with untreated multiple myeloma. Leukemia 2016;30:1320\u20131326."},{"key":"B78","series-title":"Haematologica","first-page":"1937","article-title":"Lenalidomide-based induction and maintenance in elderly newly diagnosed multiple myeloma patients: updated results of the EMN01 randomized trial","volume":"105","author":"Sara B","year":"2020","unstructured":"Sara B, Mattia DA, Laura P,  Lenalidomide-based induction and maintenance in elderly newly diagnosed multiple myeloma patients: updated results of the EMN01 randomized trial. 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