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Young, fit, high-risk
Young, clinically fit patient with newly diagnosed multiple myeloma and high-risk disease. Assess transplant candidacy based on overall health, performance status, frailty, comorbidities, and organ function rather than chronological age alone.
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Young, fit, standard-risk
Young, clinically fit patient with newly diagnosed multiple myeloma and standard-risk disease. This branch preserves ASCT as an option while allowing an individualized discussion of upfront versus deferred transplantation.
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Defer stem cell transplant upfront
Defer upfront ASCT. Stem cells may be collected and stored. Reconsider transplantation on a case-by-case basis if residual disease remains after 6–8 cycles of quadruplet therapy.
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Older (~≥70 years), unfit, no improvement in performance status
Older patient, approximately ≥70 years, who remains clinically unfit without meaningful improvement in performance status despite myeloma treatment. Applies regardless of disease-risk category.