IMWG FRAILTYGeriatric Assessment for Multiple Myeloma
Age & Comorbidity
Functional Assessment
Awaiting Age Input
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
Clinical Use
Newly diagnosed Multiple Myeloma patients, especially those > 65 years old.
To guide the starting dose of induction regimens (e.g., VRd, Dara-VMP).
To identify patients who are at high risk for treatment-related toxicities and early discontinuation.
How it Works
Scoring Components (0-5 Points)
| Variable | Criteria | Points |
|---|---|---|
| Age | 75-80 years / > 80 years | 1 / 2 |
| Charlson Comorbidity Index | > 2 | 1 |
| ADL (Katz) | Score ≤ 4 | 1 |
| IADL (Lawton) | Score ≤ 5 | 1 |
Frailty Categories
| Score | Category | Implication |
|---|---|---|
| 0 | Fit | Standard dose triplet/quadruplet therapy. |
| 1 | Intermediate-fit | Triplet therapy with planned dose reductions. |
| ≥ 2 | Frail | Doublet therapy or significant dose attenuation. |
Clinical Pearls
The "Frail" Paradox
Aggressive therapy in frail patients often leads to treatment discontinuation due to toxicity before any clinical benefit is achieved. The IMWG score proved that "less is more" in this cohort: dose-attenuated therapy leads to better overall survival than full-dose therapy that is interrupted.
Functional Assessment
Unlike the ECOG status which is a subjective clinician assessment, the ADL/IADL components of the IMWG score provide a more granular view of the patient's daily independent function, which is a powerful independent predictor of mortality in myeloma.
The Evidence
Key Reference
Geriatric assessment predicts survival and toxicities in elderly newly diagnosed multiple myeloma patients: an International Myeloma Working Group report
Palumbo A et al. • Blood. 2015;125(13):2068-74
Last Comprehensive Review: 2026