Treatment Intensity in the Frontline Setting for Transplant-Ineligible Patients With Multiple Myeloma

Authors

• Mark Davis, University of LynchburgFollow

Specialty

Medical Oncology

Advisor

Patrick Griffin MD

Abstract

The management of newly diagnosed transplant-ineligible multiple myeloma

(NDTIMM) remains challenging, largely because frailty complicates treatment

decisions and frequently leads to the exclusion of frail patients from pivotal clinical

trials. Recent subgroup analyses provide useful insight into whether quadruplet

therapy may offer advantages over triplet therapy in this population. Data from the

IMROZ and CEPHEUS trials were reviewed to compare outcomes between

quadruplet and triplet regimens in both the overall intent-to-treat cohorts and the

frailty-defined subgroups. Frailty was assessed using the International Myeloma

Working Group (IMWG) frailty index in CEPHEUS and the simplified IMWG frailty

score in IMROZ. Across both trials, frail and non-frail patients receiving quadruplet

therapy demonstrated longer progression-free survival (PFS) and higher rates of

minimal residual disease negativity (MRD) compared with those receiving triplet

therapy. These findings suggest that quadruplet regimens may provide

meaningful clinical benefit even among selected frail patients when treatment

decisions are guided by comprehensive frailty assessment and individualized

clinical judgment. Additional real-world evidence is needed to confirm tolerability,

optimize patient selection, and further clarify the role of quadruplet therapy in this

vulnerable population.

Recommended Citation

Davis M. Treatment Intensity in the Frontline Setting for Transplant-Ineligible Patients With Multiple Myeloma. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).