Treatment Selection at First Relapse in Relapsed/Refractory Multiple Myeloma

Dr. Joshua Richter and Dr. Surbhi Sidana discuss factors that guide treatment selection at first relapse in relapsed/refractory multiple myeloma, including prior treatment exposure, refractoriness, duration of response, disease biology, and patient preferences. Dr. Sidana reviews available treatment options, including BCMA-directed CAR T-cell therapies, bispecific antibodies, antibody-drug conjugates (ADCs), and other combination regimens. She emphasizes the importance of considering patient fitness, treatment access, and individual preferences when choosing between immunotherapy approaches. The discussion highlights the potential for CAR T-cell therapy to provide a treatment-free interval, balanced against the risk of serious toxicities, while bispecific antibodies offer an alternative that requires ongoing treatment and carries infection-related considerations. Dr. Richter shares his approach to patients who experience early relapse following frontline quadruplet therapy, emphasizing the importance of moving to a different treatment strategy and considering BCMA-directed therapies.