Comprehensive Geriatric Assessment of Older Patients with Multiple Myeloma: A Prospective Observational Study

<b>Background/Objectives</b>: Multiple myeloma (MM) predominantly affects older adults, a heterogeneous population. Comprehensive Geriatric Assessment (CGA) and abbreviated tools support individualized treatment planning. This study aimed to evaluate the feasibility of CGA and its impact on clinical outcomes in this subgroup of patients. <b>Methods</b>: Prospective, observational, and single-center study including patients aged ≥65 years assessed at MM diagnosis and one year later in an onco-hematogeriatrics clinic. A CGA was performed, and frailty was evaluated using the following: G8, Geriatric Assessment in Hematology (GAH), Clinical Frailty Scale (CFS), Frail-VIG Index (FI-VIG), modified Fried phenotype, International Myeloma Working Group Frailty Index (IMWG-FI), and Revised Myeloma Comorbidity Index (R-MCI). At one year, patients were reassessed; treatment response (IMWG criteria), adverse events (CTCAE v5.03), and mortality were recorded. <b>Results</b>: Fifty-five patients (mean age 78.0 ± 5.4 years, 58.2% female) diagnosed between December 2019 and May 2024 were included. CGA completion exceeded 90% at both time points. At one year, 9 patients (16.4%) had died, and 16 (29.1%) achieved complete response, with daratumumab-lenalidomide-dexamethasone (DRd) being the most used regimen. Frailty prevalence significantly declined (FRAIL: <i>p</i> = 0.012; CFS: <i>p</i> = 0.016; IMWG-FI: <i>p</i> = 0.020). GAH was significantly associated with ≥grade 3 hematologic toxicity (OR = 5.67, <i>p</i> = 0.004) and mortality (AUC = 0.750, <i>p</i> = 0.027). FI-VIG also predicted mortality (OR = 14.67, <i>p</i> = 0.026). <b>Conclusions</b>: CGA and its abbreviated forms are feasible and clinically valuable tools for identifying vulnerable older adults with MM, enabling treatment individualization and improved risk stratification.