Induction Therapy Strategies in the Transplant-Ineligible Population

Multiple myeloma (MM), a plasma cell malignancy, accounts for ~10% of hematologic malignancies and predominantly affects the older population. It exhibits a heterogeneous biology and a complex genetic phenotype that affect patient prognosis. The treatment of MM has evolved significantly over the last decade with the use of autologous stem cell transplantation and several novel agents. Consequently, outcomes have improved in this time period, with the most impact in younger patients. Management of MM in elderly frail patients requires a thoughtful approach as majority of these patients carry multiple comorbidities and are precluded from high-dose chemotherapy and autologous stem cell transplantation-accounting for the more modest improvement in outcomes. Assessing transplant eligibility and performance status is a critical first step. Subsequently, the choice of frontline therapy in transplant-ineligible frail patients must balance efficacy with adverse effects to optimize quality of life. Here, we review the current state of induction regimens in this patient population.