A Fresh Look at Frailty in Multiple Myeloma

A crucial guideline from the UK Myeloma Research Alliance on the "Assessment and treatment of frail patients living with multiple myeloma" has been published. Why is this essential for your FRCPath haematology exam prep? Because modern haematology isn't just about choosing the most powerful drug; it's about tailoring treatment to the individual. To pass the FRCPath exam, you must demonstrate an ability to manage complex cases, and understanding frailty is key.

Link to guidelines: https://onlinelibrary.wiley.com/doi/10.1111/bjh.70041

Why Frailty Matters

With an arsenal of new treatments for myeloma (including bispecifics like elranatamab and teclistimab), the focus has shifted to balancing survival with quality of life. For older or less fit patients, standard regimens can cause significant toxicity. This new guideline is perfect for tackling Haematology Part 1 essay questions that explore patient-centred care. It provides a framework for nuanced assessment, moving beyond a simple "fit vs. unfit" classification.

Key Learning Points for Your Exam

• How to Assess Frailty: You should be familiar with validated frailty scoring systems like the IMWG score. Success in your FRCPath haematology will depend on your ability to describe how you would assess a patient's age, comorbidities, and functional status at the bedside. The preferred frailty tool is the full IMWG-FS for newly diagnosed MM patients. An excellent video on the topic can be found here: https://www.youtube.com/watch?v=sG3Ky3Zu46g

🧠 Mnemonic for IMWG-frailty score: Always Check Individual Abilities (Age, Charlson Comorbidity Index, Instrumental ADLs, ADLs)

• Tailoring Treatment: For frail patients, the goal is controlling the disease while maintaining quality of life. The guideline makes recommendations for the initial regimen for newly diagnosed myeloma patients ("Consideration should be given to commencing a quadruplet regimen such as anti-CD38-VRD in those aged <80 years and deemed to be fit by frailty scoring and in selected patients deemed to be intermediate fit by frailty scoring") and appropriate dose modifications. Test your knowledge on myeloma management using the AceHaematology question bank!

• Beyond the Drugs: Frailty assessment isn't a one-off event. It is a dynamic process that can be improved with good supportive care. The guidelines provide excellent recommendation on appropriate supportive care.

🧠 Exam Tip: A typical FRCP haematology exam scenario might present an elderly patient with myeloma and ask for a management plan. The best answers will explicitly mention performing a formal frailty assessment and will justify the choice of a dose-modified regimen based on the patient's frailty status, not just their age. Mastering this is a vital part of your haematology UK exam preparation.