Nuanced treatment decision in newly diagnosed multiple myeloma patients aged 65–75 years: a real-world study

PURPOSE: The optimal treatment strategy for patients aged 65-75 years with multiple myeloma (MM) remains undefined, as most clinical trials involving transplant-eligible patients have excluded this subgroup. We investigated the real-world treatment patterns, outcomes, and clinical impact of autologous stem cell transplantation (ASCT) and quadruplet therapy in this population. METHODS: We retrospectively analyzed 561 patients aged 65-75 years with newly diagnosed MM treated between 2015 and 2023 at two tertiary centers. Patients were stratified by age (< 70 vs. ≥ 70 years) and ASCT status. RESULTS: The use of quadruplet regimens and ASCT has increased markedly since 2021. Among patients aged 65-69 years, ASCT was associated with improved progression-free survival (PFS) (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.27-0.53; P < 0.001) and overall survival (HR, 0.30; 95% CI, 0.17-0.55; P < 0.001). In those aged 70-75 years, quadruplet therapy was independently associated with superior PFS (HR, 0.29; 95% CI, 0.12-0.73; P = 0.009). Similarly, in non-transplant recipients, quadruplet therapy remained a favorable predictor of PFS (HR, 0.40; 95% CI, 0.19-0.87; P = 0.021). CONCLUSION: Intensive treatment strategies-including ASCT and quadruplet therapy-are both feasible and beneficial for selected patients with MM aged ≥ 65 years. Therefore, chronological age alone should not be used to determine treatment eligibility. These findings provide real-world evidence that supports a shift toward individualized fitness-based treatment approaches to optimize outcomes in older patients with MM.