First relapse in older adults with multiple myeloma: Creating new pathways in uncharted territory.

Treatment options for older adults with relapsed multiple myeloma are constrained by the toxicities of existing treatments, the ageing-associated vulnerabilities that may increase the risk of poor treatment tolerance and patient preferences for treatments that do not impair their function or cognition. The study by Toussea et al. epitomizes approaches to designing trials specifically for more vulnerable older adults and moves the field forward with a regimen of great interest for older adults experiencing their first relapse. Commentary on: Touzeau et al. Iberdomide, Ixazomib and Dexamethasone in elderly patients with multiple myeloma at first relapse. Br J Haematol 2025; 206:1366-1372.