Frontline Therapy in NDMM: Defining Transplant-Ineligible vs Transplant-Deferred and Choosing Triplets vs Quads

This segment explores the evolving frontline treatment landscape in newly diagnosed multiple myeloma (NDMM) for patients who are transplant-ineligible or transplant-deferred. The discussion reviews how current guidelines and phase 3 data, including the MAIA and CEPHEUS trials, have expanded treatment options beyond traditional triplet regimens. Faculty discuss the importance of distinguishing truly transplant-ineligible patients, who are often frail or older, from fitter individuals who defer transplant but remain candidates for more intensive therapy.

The panel outlines practical considerations for selecting between a Dara-lenalidomide-dexamethasone (Dara-Rd) triplet and quad-based induction regimens. While MAIA-like triplets remain appropriate for frail patients, quad regimens may be preferred for fit transplant-deferred patients to maximize depth and durability of response and MRD negativity. The discussion also addresses how clinical trial regimens are adapted in real-world practice, including modifications to bortezomib dosing schedules while maintaining overall cumulative exposure.