Early Relapse Treatment and Sequencing in Multiple Myeloma

Dr. Hans Lee, Dr. Muhamed Baljevic, and Dr. Prashant Kapoor discuss evolving treatment strategies for early relapse and relapsed/refractory multiple myeloma, focusing on recent evidence for T-cell redirecting therapies. Dr. Lee highlights results from the MajesTEC-3 and MajesTEC-9 studies, which demonstrated progression-free and overall survival benefits with teclistamab-based approaches in patients with relapsed multiple myeloma. Dr. Baljevic explains how these data, along with findings from CARTITUDE-4, are influencing treatment selection in the second-line setting, including his preference for BCMA-directed CAR T-cell therapy before bispecific antibody therapy when feasible. The experts also examine factors that may guide selection between teclistamab combination therapy and monotherapy, including prior CD38 antibody exposure, treatment tolerance, and infection risk. Dr. Baljevic emphasizes the importance of proactive supportive care, including IVIG replacement and antimicrobial prophylaxis, to mitigate infectious complications associated with BCMA-directed bispecific therapy. The discussion concludes by acknowledging remaining evidence gaps regarding which patients are best suited for combination versus single-agent approaches in relapsed multiple myeloma.