Treatment Selection at Early Relapse in Multiple Myeloma

Tanika Pittman, APRN, discusses the individualized approach to selecting subsequent therapy for patients with multiple myeloma experiencing early relapse. She emphasizes starting with a detailed review of the patient’s treatment history and disease biology, including frontline therapies, prior exposure and refractoriness to agents such as anti-CD38 antibodies and lenalidomide, and the duration and quality of the initial response. Additional disease-related considerations include whether relapse is biochemical or clinical, the aggressiveness and rate of disease progression, cytogenetic risk, and the presence of extramedullary disease. Tanika also highlights patient-specific factors that may influence treatment selection, including renal and cardiac function, neuropathy, performance or functional status, prior toxicities, infection history, caregiver support, and treatment preferences. She stresses that treatment decisions should consider not only the next available regimen but also the broader sequencing strategy and whether certain therapies should be preserved for later lines. Jill Burke, NP, adds the importance of reassessing the patient’s family and social circumstances, comorbidities that may have developed over time, and changes in disease risk. The discussion underscores the value of experienced multidisciplinary care when navigating multiple myeloma relapse and sequencing decisions.