Multiple myeloma (MM) is primarily a disease of elderly patients. Geriatric aspects in the context of MM have been poorly investigated until recently. Treatment outcomes for geriatric patients with MM are often compromised by comorbidities and an enhanced susceptibility to adverse events from therapy. Assessment of patient frailty has become more frequent and will be useful in the context of significant and continuous advances in therapy. The recent emergence of immunotherapy with CD38 monoclonal antibodies and upcoming immuno-oncology drugs, such as bispecific antibodies, will lead to additional therapeutic progress. The applicability of these new molecules to elderly and frail patients is a key clinical question. Here we present 2 patient cases derived from clinical practice. We review current frailty scores and standards of care for elderly newly diagnosed patients with MM, including frail subgroups, and discuss ways to tailor treatment as well as treatment perspectives in this population.