The treatment landscape continues to evolve towards the application of precision medicine in Multiple Myeloma (MM), and there is a clear need to maximise therapy efficacy whilst minimizing toxicity, ensuring the best possible treatment delivery. How to highlight who is at risk? Integral to this is defining the physiological age and capacity of patients with MM to deal with the burden of their disease and it’s treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. We need to develop, test and validate such clinical screening scores before their adoption into clinical practice is adopted to direct safe, effective and personalized treatment.