Exploring the Treatment Options for RRMM

Physician Summary: Current Treatment Options and the Role of Disease Progression in RRMM

For patients with relapsed/refractory multiple myeloma (RRMM), several advanced treatment options are available, and the rate of disease progression plays a critical role in guiding therapy selection.

Available Treatment Options:

• Second Autologous Stem Cell Transplant (auto-HSCT): May be considered as salvage therapy in patients with favorable performance status and a durable initial response.

• CAR T-Cell Therapy (CAR T):

• Idecabtagene vicleucel (ide-cel): Supported by data from KarMMa-3, demonstrating improved outcomes in triple-class–exposed patients.

• Ciltacabtagene autoleucel (cilta-cel): From CARTITUDE-4, showing significant responses in early relapsed, lenalidomide-refractory patients.

• Bispecific Antibodies:

• Agents such as elranatamab, teclistamab, and talquetamab offer off-the-shelf options with rapid onset of action and are particularly valuable in patients with rapidly progressing disease or those not eligible for CAR T.

Role of Disease Progression:

• Rapid progression favors use of readily available therapies, such as bispecific antibodies, due to urgency and shorter lead time.

• Slower progression allows consideration of CAR T therapy, which involves manufacturing time but offers potential for durable responses.

• Second auto-HSCT remains an option in select patients with late relapse and preserved functional status.

Therapy should be tailored based on disease kinetics, prior treatments, and patient-specific factors, with growing emphasis on sequencing and timely access to novel immunotherapies.