Quadruplet Regimens and T-Cell Redirection Are on the Map of Myeloma Management Strategies: With Chandler Park, MD; Muhamed Baljevic, MD, FACP

In this episode of Oncology Unplugged, host Chandler Park, MD, a medical oncologist at Norton Cancer Institute in Louisville, Kentucky, was joined by Muhamed Baljevic, MD, FACP, an associate professor of medicine in the Division of Hematology Oncology in the Department of Medicine at the Vanderbilt-Ingram Medical Center; as well as the director of the Multiple Myeloma Program and the Vanderbilt Amyloidosis Multidisciplinary Program and co-chair of the Protocol Review and Monitoring System at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee.

Their conversation focused on the rapid evolution of the multiple myeloma treatment paradigm, including the integration of quadruplet therapies, the clinical emergence of bispecific antibodies and CAR T-cell therapies, and the management of treatment-related toxicities. Drs Park and Baljevic examined data regarding quadruplet regimens, which are now the standard of care for transplant-eligible patients. They highlighted trial findings showing that patients with sustained minimal residual disease (MRD) negativity could successfully de-escalate maintenance therapy.

For relapsed disease, they discussed clinical trials investigating teclistamab, noting the agent's robust efficacy in the early-relapsed setting and among patients who have been previously refractory to CD38-targeted antibodies. The experts also discussed individualizing treatment through target switching and sequencing CAR T-cell therapy before bispecific antibodies to optimize T-cell health. To manage cytokine release syndrome, they recommended tocilizumab prophylaxis or the use of dexamethasone. Furthermore, Dr Baljevic highlighted the use of “flat-dose” intravenous immunoglobulin to mitigate infection risks, which maintains safety and significantly reduces financial toxicity and resource strain compared with weight-based dosing.

Regarding cellular therapies, the experts reaffirmed the potential for functional cures even in heavily pretreated patients. They also spotlighted the use of MRD status to stratify transplant-eligible patients to undergo autologous stem cell transplant vs T-cell redirection consolidation therapy.

Drs Park and Baljevic concluded by discussing MRD-informed treatment cessation. Dr Baljevic indicated that patients with standard-risk disease with 5 years of sustained MRD negativity could consider stopping maintenance therapy, but emphasized that patients with high-risk disease still require continuous treatment.