Definition of symptomatic myeloma: i.e., bone marrow clonal b-cells ≥10% or biopsy-proven plasmacytoma with one or more of the following: hypercalcemia, renal insufficiency, anemia, and bone lesions. Bone marrow clonal plasma cells ≥60%, FLC ratio >100, and >1 bone lesion on MRI will also be present. Those with these conditions should be diagnosed with symptomatic MM and require clinical treatment. It should be particularly emphasized that in both SMM and symptomatic myeloma, high-risk cytogenetics is only prognostically relevant and is not a condition for the need for treatment. Even if accompanied by high-risk cytogenetic abnormalities, but do not meet the criteria for symptomatic MM, clinical treatment is not required. For newly diagnosed symptomatic myeloma, the first step is to determine whether the patient is amenable to autologous peripheral blood hematopoietic stem cell transplantation based on the patient’s age. Previously, good or bad cellular function had been used as a condition for the ability to receive transplantation, but now it is believed that organ insufficiency is not a contraindication to autologous peripheral blood stem cell transplantation. It is only the increased risk associated with transplantation in patients with vital organ insufficiency who receive autologous peripheral blood stem cell transplantation. The age limit for autologous peripheral blood stem cell transplantation is generally accepted by scholars as 65 years, but it is 70 years in the United States and 75 years in Europe. For patients who are suitable for autologous peripheral blood stem cell transplantation, autologous peripheral blood stem cell transplantation is usually performed after 4 – 6 courses of induction therapy with triple drug combinations containing newer drugs. The newer drugs include: Bortezomib, Lenalidomide and Thalidomide. The efficacy of three-drug combination chemotherapy regimens containing the newer drugs is similar, and the exact combination can be selected on a patient-by-patient basis. Bortezomib-based regimens are recommended for patients with renal insufficiency, cardiomyopathy, hematopenia, and thrombotic events. Patients with peripheral neuritis can be treated with lenalidomide-based induction therapy. Studies have found that triple-drug combinations containing bortezomib prolong not only progression-free survival (PFS) but also overall survival (OS) in patients. Although the near-term remission rate of the three-drug combination regimen containing lenalidomide was significantly higher, it did not prolong PFS and OS compared with MPT (thalidomide + melphalan + prednisone), and therefore it is necessary to explore the drug combinations, dosages, and number of courses of lenalidomide-containing regimens in patients with newly diagnosed MM in order to prolong PFS and OS based on an improved remission rate. Previous guidelines have generally set the pre-transplantation induction therapy The number of courses of induction therapy prior to transplantation was defined as 4. However, recent studies have found that the effect of induction therapy prior to transplantation correlates with long post-transplant survival, and therefore the new criteria recommend that the number of courses of induction therapy be defined as 4–6. If 4 courses of induction therapy result in ≥ very good partial remission (VGPR), auto–PBSCT can be performed; if 4 courses of induction therapy result in ≤ PR, it is recommended to increase the number of courses of induction therapy to 6, followed by autologous peripheral blood stem cell transplantation. For patients suitable for auto–PBSCT, alkylating agents (melphalan) should not be used for induction therapy; lenalidomide has stem cell damaging effects, and induction therapy should not be used for more than 6 courses, otherwise it may affect stem cell collection. For patients who are not suitable for auto–PBSCT, patients should be scored according to their physical status to determine the treatment plan. Commonly used scoring criteria are ADL, IADL and Charlson scoring systems. Based on these scoring systems, elderly MM patients are categorized as good, fair and fragile. For good-type patients, similar regimens and intensities as those for younger patients are used; for average-type patients, reduced chemotherapy is needed; and for fragile-type patients, the benefit-to-risk ratio of chemotherapy should be considered, and supportive therapy is often the mainstay. Therefore, treatment for elderly patients should be individualized based on functional status scores. The number of courses of induction therapy recommended for patients unsuitable for transplantation is 9–12. For patients who achieve rapid complete remission, the number of induction therapy sessions can be 9, while for patients who do not achieve complete remission, the number of induction therapy sessions should be 12. For older adults older than years, a three-drug combination regimen containing a new drug is advocated, whereas for patients ≥75 years of age, three-drug combinations do not prolong PFS and OS compared to two-drug combinations containing a new drug, and three-drug combinations are associated with greater side-effects and are less well tolerated by patients.