Frailty profile precluding standard-dose VRd / D-VRd induction in MM: IMWG frailty score...
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | RF-MM-FRAILTY-AGE |
|---|---|
| Type | Red flag |
| Status | reviewed 2026-04-25 | pending_clinical_signoff |
| Diseases | DIS-MM |
| Sources | SRC-ESMO-MM-2023 SRC-NCCN-MM-2025 |
Red Flag Origin
| Definition | Frailty profile precluding standard-dose VRd / D-VRd induction in MM: IMWG frailty score ≥2 (defined by age ≥80 OR age 75-79 + Charlson ≥2 OR ECOG ≥2 + albumin <3.5), OR age ≥75 with ≥1 grade-2 cardiac/pulmonary comorbidity. Impacts dose schedule (Vd-Rd weekly vs twice-weekly, reduced lenalidomide, reduced dexamethasone), not regimen choice. |
|---|---|
| Clinical direction | de-escalate |
| Category | frailty-age |
| Shifts algorithm | ALGO-MM-1L |
Trigger Logic
{
"any_of": [
{
"comparator": ">=",
"finding": "imwg_frailty_score",
"threshold": 2
},
{
"all_of": [
{
"comparator": ">=",
"finding": "age",
"threshold": 80
}
]
},
{
"all_of": [
{
"comparator": ">=",
"finding": "age",
"threshold": 75
},
{
"comparator": ">=",
"finding": "ecog",
"threshold": 2
},
{
"comparator": "<",
"finding": "albumin_g_dl",
"threshold": 3.5
}
]
}
],
"type": "composite_score"
}
Notes
IMWG frailty score (Palumbo 2015) is validated against survival on novel-agent regimens. Frail patients on full-dose VRd have ≈15-20% treatment-related mortality vs ≈3% on dose-modified schedules. Dose-modified VRd (V weekly, R 15-25 mg, dex 20 mg weekly) preserves efficacy with substantially better tolerability. This RF de-escalates toward IND-MM-1L-VRD with dose-modified schedule (when high-risk cytogenetics + frailty co-occur — both step 1 and this trigger fire, intensify takes precedence per direction order; engine surfaces both).
Used By
Algorithms
ALGO-MM-1L- ALGO-MM-1L
Indications
IND-MM-ELDERLY-FRAIL-VRD-LIGHT- IND-MM-ELDERLY-FRAIL-VRD-LIGHT