Exploring the prognostic value of the FIRST simplified frailty scale in elderly, transplant-ineligible, newly diagnosed multiple myeloma patients in real-world settings

Abstract Objective To evaluate the prognostic value of the FIRST simplified frailty scale in a real-world cohort of elderly (age > 65 years), newly diagnosed multiple myeloma (MM) patients ineligible for autologous transplantation. Methods We retrospectively reviewed clinical records of 43 consecutive MM patients aged over 65 years treated at our center between January 2016 and December 2023. Frailty was determined using the FIRST simplified scale, classifying patients as frail (n = 29) or not frail (n = 14). We compared treatment efficacy, treatment-related adverse events and survival outcomes between the two groups. Results The ORR was 96.6% in the frail group and 100% in the not frail group ( P > 0.05 ). The proportion of frail patients achieving VGPR or better was significantly lower than that of not frail patients (58.6% vs 92.9%; P < 0.05 ). Incidences of hematological and non-hematological adverse events were similar in both groups. Median Progression-Free Survival (PFS) was 12 months in frail patients versus 25.5 months in not frail patients ( P < 0.05 ), and median Overall Survival (OS) was 17 months versus 34.7 months, respectively ( P < 0.05 ). Conclusion Elderly MM patients experience higher rates of treatment-related adverse events and worse survival than younger counterparts, and the FIRST simplified frailty scale offers a practical, valuable tool for risk stratification in this population.