Treatment Sequencing Considerations in Smoldering Multiple Myeloma

In this segment, Dr. Sagar Lonial asks the panel to discuss how early treatment strategies may influence future therapy options if patients with smoldering multiple myeloma eventually progress to active disease. Dr. Vincent Rajkumar notes that one concern with initiating therapy earlier in the disease course is the potential impact on treatment sequencing later in the patient journey. Exposure to agents such as anti-CD38 antibodies during the smoldering stage could influence how patients respond to similar therapies when active multiple myeloma develops. Dr. Saad Usmani adds that clinicians must consider whether early treatment might limit or alter subsequent treatment choices, particularly as many effective regimens for active disease also include anti-CD38–based combinations. The panel highlights that while early intervention may delay progression in selected patients, understanding the long-term implications for retreatment and therapeutic sequencing remains an important consideration in the management of smoldering multiple myeloma.