Introduction Elderly patients with multiple myeloma (MM) represent a heterogeneous population, and the efficacy has not been further improved in the era of new drugs. The European Myeloma Network (EMN) recommends that frailty assessment be conducted for elderly patients with newly diagnosed multiple myeloma (NDMIM) to avoid overtreatment and undertreatment. The Inter- national Myeloma Working Group Frailty Index (IMWG-FI) is considered the "gold standard" for evaluating frailty in elderly MM patients. It is of great importance to explore optimal treatment strategies for elderly NDMM.