Combination Therapy Approaches in Smoldering Multiple Myeloma

In this segment, Dr. Sagar Lonial asks Dr. Saad Usmani to discuss emerging data evaluating combination treatment strategies in smoldering multiple myeloma. The conversation focuses on studies exploring anti-CD38 antibodies combined with immunomodulatory agents, as well as data involving alternative anti-CD38 therapies such as isatuximab. Dr. Usmani explains that these combination approaches aim to achieve deeper disease control in patients with high-risk smoldering multiple myeloma by targeting multiple biological pathways. However, he notes that the use of combination therapy in an asymptomatic population raises important considerations. Factors such as treatment intensity, safety profile, duration of therapy, and the long-term implications for patients who have not yet developed symptomatic disease must be carefully evaluated. The panel highlights that while combination strategies may offer promising activity, clinicians must balance potential benefits with the goal of avoiding unnecessary treatment exposure in patients with smoldering multiple myeloma.