ARTICLE IN PRESSJID:CLML[mNSMarch14,202312可Review ArticleFirst Line Treatment of Newly DiagnosedTransplant Ineligible Multiple Myeloma:Recommendations from the Canadian MyelomaResearch Group Consensus GuidelineConsortiumJulie Cote,Rami Kotb,b Debra J.Bergstrom,Richard LeBlanc,d Hira S.Mian,Ibraheem Othman,'Martha L.LouzadasAbstractAlthough the availability of effective novel treatments has positively impacted the quality of life and survival of newlydiagnosed multiple myeloma (MM)patients,benefits in the transplant ineligible MM population may be limited byfunctional/frailty status.The Canadian Myeloma Research Group Consensus Guideline Consortium proposes consen-sus recommendations for the first-line treatment of transplant ineligible MM.To address the needs of physicians andpeople diagnosed with MM,this document further focuses on eligibility for transplant,frailty assessment,managementof adverse events,assessment of treatment response,and monitoring for disease relapse.The Canadian MyelomaResearch Group Consensus Guideline Consortium will periodically review the recommendations herein and update asnecessary.Clinical Lymphoma,Myeloma and Leukemia,Vol.000,No.xxx,1-15 Crown Copyright2023 Published by Elsevier Inc.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/)Keywords:Adverse events,Guidelines,Frailty assessment,Response and relapse monitoring,TIMM,Upfront treatmentIntroductionevaluation,it is crucial for treatment to be individualized and thenOverviewadapted based on treatment response and adverse events.Multiple myeloma(MM)is a plasma cell malignancy that primar-This consensus guideline describes the best-practice approachily affects older adults.Although it is most frequently diagnosedto the first-line treatment of transplant ineligible MM (TIMM),among people aged 65 to 74 years,approximately one-third of newlywith the aim of achieving the best possible response while limit-diagnosed patients are over the age of75 years.The goals of first-ing toxicity and avoiding treatment complications.The objectiveline treatment in this older MM population (>65 years)are impor-is to provide clinicians with concise recommendations upon whichtant to establish.Comorbidities and/or frailty often contribute totreatment decisions can be made.This review will focus on patientsmanagement challenges that can include ineligibility for autologousdeemed to be ASCTineligible due to chronological age,comorbidi-stem cell transplantation(ASCT).Thus,following a global patientties,and functional/frailty status,which represent a heterogenousCentre hospitalier universitaire de Qudbec,Quebec,QC,Canadare Manitoba,University of Manitoba,Winnipeg,MB,CanadaMemorial University of Newfoundland St.John's,NL,CanadadHopital Maisonneuve-Rosemont,University of Montreal,Montreal,QC,CanadaJuravinski Cancer Centre,MeMaster University,Hamilton,ON,CanadaSubmitted:Nov 28,2022;Revised:Jan 14,2023;Accepted:Jan 30,2023;Epub:xxxAddress
