Frailty in elderly is associated with negative outcomes and high mortality. In frail patients diagnosed with Multiple Myeloma (MM), it's advisable to adjust the dosages of antineoplastic treatments to minimize associated toxicities.

This study aims to present two clinical cases emphasizing the safety profile of Daratumumab in frail patients with MM.

MM patients receiving Daratumumab underwent a specialized geriatric assessment protocol. For frailty assessment, the modified Fried frailty criteria and the Frail Scale were utilized. The Lawton scale gauged functionality in instrumental activities of daily living (IADL), while sarcopenia assessment was conducted following the updated guidelines from the European Working Group on Sarcopenia. The study included elderly patients meeting three or more criteria on the Frail Scale.

Two frail patients diagnosed with MM were assessed during treatment with Daratumumab, Bortezomib, an alkylating agent, and corticosteroids, followed by Daratumumab maintenance. The first patient, S.N.C., aged 64, had type 2 diabetes mellitus, history of falls, osteoporosis with lytic bone lesions, and spinal fractures. She also had severe IADL dependence (scored 11 out of 27 on the Lawton scale) and used a wheelchair, having been independent earlier. She also displayed signs of sarcopenia. On the Frail Scale, she scored 3 of the 5 points. The initial treatment spanned seven cycles before transitioning to monthly maintenance. No dose modifications were required. After 6 months of therapy, the patient reported symptomatic relief, improved motor functions, regained walking abilities, and increased independence in IADL. The second patient, G.P.F., aged 78, had no notable comorbidities, but had several osteolytic lesions and fractures evident on CT scans. He was frail, dependent on IADL, exhibited nutritional risk and history of falls. He underwent a four-drug treatment for six cycles, subsequently establishing monthly maintenance. Upon reevaluation after completing the treatment cycles, he reported no outstanding complaints, regained his ambulation, and cited feeling well with a noted improvement in his IADL dependence.

Patients exhibiting frailty syndrome generally experience poorer outcomes and a higher rate of complications linked to therapeutic interventions across multiple clinical contexts. The efficacy of Daratumumab has been substantiated in the MAIA and ALCYONE trials for non-eligible patients per investigator subjective criteria. In the “frailty” sub-analysis of the MAIA study, geriatric assessment was not performed, and patients with high comorbidity scores were included. We present two cases with geriatric assessments and established frailty syndrome criteria who showed favorable outcomes with the chosen regimen, without need for dose adjustments.

The administration of Daratumumab to frail patients in this study was safe and results in swift clinical responses. Thiago Xavier Carneiro receives honoraria from Janssen.