Combination Strategies and Sequencing in Relapsed/Refractory Multiple Myeloma

Dr. Hans Lee and the panel discuss emerging combination strategies and treatment sequencing for patients with relapsed/refractory multiple myeloma. Dr. Jing Christine Ye reviews findings from the DREAMM-8 study, highlighting its relevance to patients treated at first relapse and the progression-free survival benefit observed with belantamab mafodotin plus pomalidomide and dexamethasone compared with the control regimen. Dr. Douglas Sborov emphasizes that multiple myeloma is generally treated with combination regimens and discusses the rationale for identifying effective partners for newer therapies, including BCMA-directed bispecific antibodies. The panel considers how prior treatment exposure and refractoriness, particularly to immunomodulatory drugs and proteasome inhibitors, may influence subsequent combination choices. Dr. Paul Richardson cautions that the sequencing and combination of potent immune-activating therapies require careful consideration. He also discusses the evolving understanding of immune exhaustion following BCMA-directed therapy and the potential role of intervening small-molecule therapies to restore immune function before subsequent immunotherapeutic approaches. The discussion underscores the rapidly evolving nature of sequencing and combination strategies in relapsed/refractory multiple myeloma.