Expert Insights On An Evolving Treatment Landscape In Multiple Myeloma: Updates From EHA 2025

Panelists discuss how transplant eligibility should be viewed as a continuum based on frailty rather than a binary decision, with most patients collecting stem cells but only about 20% receiving delayed transplants.

Panelists discuss how recent trial data from ADVANCE and PERSEUS demonstrate that quadruplet regimens with daratumumab plus transplant achieve superior minimal residual disease (MRD) negativity rates compared with triplet regimens but emphasize the importance of sustained MRD negativity for long-term outcomes.

Panelists discuss how the CEPHEUS trial data showed that quadruplet therapy benefits primarily standard-risk patients rather than high-risk cytogenetic groups in transplant-ineligible populations, contrary to expectations.

Panelists discuss how truly transplant-ineligible frail patients in CEPHEUS still benefited from quadruplet therapy despite increased infection risks and provide practical tips for community oncologists on implementing CD38 antibody–containing regimens.

Panelists discuss how updated data from the IMROZ trial confirm the benefit of adding isatuximab to VRd in transplant-ineligible patients, achieving doubled sustained MRD negativity rates, while noting that daratumumab and isatuximab appear interchangeable in clinical practice.

Panelists discuss how chimeric antigen receptor (CAR) T therapy should be considered earlier in the treatment course, particularly for functionally high-risk patients who relapse within 12 to 18 months, young patients, and older patients who could benefit from treatment-free intervals.

Panelists discuss how age should not be a barrier to chimeric antigen receptor (CAR) T therapy, emphasizing that organ function and disease control during bridging are more important factors, while acknowledging system-based capacity limitations for widespread CAR T implementation.

Panelists discuss how the CARTITUDE-1 trial’s 5-year follow-up data demonstrate that approximately one-third of heavily pretreated patients with multiple myeloma (MM) remain drug free and myeloma free, while addressing safety concerns and risk mitigation strategies for CAR T therapy.

Panelists discuss how belantamab mafodotin shows added benefit in high-risk cytogenetic subgroups and may provide a more accessible B-cell maturation antigen (BCMA)–targeting option for community practices, though questions remain about optimal sequencing and impact on future therapies.

Panelists discuss how to identify patients with hard-to-treat relapsed/refractory multiple myeloma (R/R MM) with aggressive disease who need rapid disease control, making them ideal candidates for off-the-shelf bispecific antibodies rather than chimeric antigen receptor (CAR) T therapy.

Panelists discuss how real-world data studies such as Real-TEC provide comparative effectiveness evidence for teclistamab and talquetamab, showing 60% response rates and the potential for treatment spacing without compromising efficacy.

Panelists discuss how to sequence B-cell maturation antigen (BCMA)– and GPRC5D-targeting bispecific antibodies based on patient factors, with BCMA agents having higher infection risk and GPRC5D agents causing taste changes and weight loss.

Panelists discuss how institutions have evolved from inpatient to hybrid and outpatient step-up dosing models for bispecific antibodies, using preemptive tocilizumab and patient education to reduce cytokine release syndrome rates to under 20%.

Panelists discuss how successful outpatient bispecific programs require institutional champions, 24-hour on-call support, comprehensive staff education, and preemptive tocilizumab dosing to achieve readmission rates of only 3%.

Panelists discuss how emerging combination therapies such as bispecific antibodies with chimeric antigen receptor (CAR) T cells show promising response rates in patients with heavily refractory disease, while highlighting the ongoing unmet need to improve treatment access and educate community practices on advanced therapies.