Treatment After Early Relapse and Real-World Evidence in Relapsed/Refractory Multiple Myeloma

The panel discusses treatment strategies for patients with relapsed/refractory multiple myeloma who experience early disease progression following BCMA-directed therapy, including CAR T-cell therapy. Dr. Paul Richardson describes a patient who experienced an early relapse with extramedullary disease after achieving a deep response to CAR T-cell therapy and subsequently responded to a belantamab mafodotin-based combination. The panel considers the potential role of switching therapeutic targets, including GPRC5D-directed therapy, particularly in patients with extramedullary disease. Dr. Jing Christine Ye highlights data supporting BCMA- and GPRC5D-directed combinations and discusses the potential utility of GPRC5D-directed therapy after BCMA exposure or as bridging therapy before CAR T-cell therapy. The discussion then shifts to real-world evidence for linvoseltamab in heavily pretreated, triple-class-exposed patients. Dr. Ye notes that comparative real-world analyses can provide useful context for single-arm registration data but should be interpreted cautiously because they do not have the same evidentiary strength as randomized trials. The segment emphasizes individualized sequencing and the evolving role of real-world data in treatment decision-making.