High-Risk Disease and Treatment Selection in Relapsed/Refractory Multiple Myeloma

Dr. Hans Lee and Dr. Douglas Sborov discuss how clinical trial subgroup data can inform treatment selection for patients with high-risk relapsed/refractory multiple myeloma. Dr. Sborov notes that high-risk disease remains a challenging population despite advances in treatment and emphasizes that high-risk features can reflect different clinical and biologic characteristics, including high-risk cytogenetics, extramedullary disease, and functionally high-risk disease. He highlights response data with BCMA-directed therapies across these patient populations, including outcomes reported with linvoseltamab in patients with high-risk features. Dr. Sborov also discusses the potential role of bispecific antibodies in patients with extramedullary disease and considers CAR T-cell therapy for patients with rapidly progressing or functionally high-risk disease. He references subgroup findings from DREAMM-7 and CARTITUDE-2 to illustrate outcomes observed with BCMA-directed approaches in high-risk populations. The discussion emphasizes that patient preferences, disease characteristics, and the potential role of combination approaches all contribute to individualized treatment selection and sequencing.