b'Figure 2. Survival of VRd vs. Rd in combined overall population. Kaplan-Meier analyses of patients with newly diagnosed MM, evaluating differences in survival between those initially treated with VRd (orange) and those initially treated with Rd (blue), after matching based on stage and PS within each frailty category and combining these for the overall population.and its complications likely drive this higher preva- practice, he advised. Veterans are even more under-lence of frailty, and as frailty increases, myeloma andrepresented in clinical trials than the general popula-its complications contribute disproportionately moretion. We designed this study to test the assumption that tofrailtythanother,nononcologicfrailtydeficits.thebenefitofthetripletlenalidomide-bortezomib-Therefore, more intensive (e.g., borteomib-lenalido- dexamethasone diminished in frail patients. Studies mide-dexamethasone) vs. less intensive (e.g., lenalid- that can observe real-world outcomes among differ-omide-dexamethasone) treatment for a veteran whoent treatment regimens can fill the gap in evidence left is frail with multiple myeloma may actually deliverby clinical trials in nonrepresentative populations.more effective treatment of frailty itself. The authors recommended that all veterans with The authors sought to explore this topic because,multiplemyelomareceiveafrailtyassessmentat theoptimalintensityoftreatmentinadultswhodiagnosis. In addition, they recommend that frailty are frail with multiple myeloma is often uncertain,not merely be viewed as a measure of treatment tol-giventhehigherriskofharminpatientswhoareerability but more broadly as a summary measure of frail and treated with standard, intensive regimens,a patients health status that reflects both cancer and DuMontier said.noncancer contributors, according to the authors. Randomized controlled trials directly or indirectlyDistinguishing myeloma-related vs. nononcologic, exclude patients who are frail, limiting the generaliz- aging-related contributors to frailty can help deter-ability of results to a large portion of patients treated inmine whether patients derive a net benefit or net harm 19'