Managing Frailty in NDMM: Unmet Needs, Velcade and Steroid Toxicity, and Individualizing Regimen Intensity

This segment focuses on the challenges of managing frailty in patients with newly diagnosed multiple myeloma (NDMM) who are transplant-ineligible or transplant-deferred. The discussion examines how clinicians move beyond age alone when selecting therapy, incorporating frailty assessment tools, comorbidities such as diabetes or baseline neuropathy, as well as social factors including caregiver support and travel logistics.

Faculty discuss treatment-related toxicities that may disproportionately affect older or frail patients, including proteasome inhibitor–associated neuropathy and dexamethasone-related adverse effects such as falls, functional decline, worsening cardiometabolic disease, and hospitalization risk. Strategies for individualizing regimen intensity are explored, including initiating triplet therapy with potential escalation to quad regimens in appropriate patients, or de-escalating therapy when toxicities emerge.

The conversation also addresses approaches to reducing or discontinuing steroids once a meaningful response is achieved and how clinicians weigh the balance between maintaining efficacy and minimizing treatment burden. Overall, the segment highlights the ongoing need for treatment approaches that remain effective while improving tolerability and feasibility for frail NDMM populations.