When and How to Treat Relapsed Multiple Myeloma

Abstract

The treatment landscape for relapsed multiple myeloma has expanded considerably in recent years, as numerous agents with new mechanisms of action have been introduced, increasing responses even in advanced disease and prolonging survival. The wealth of novel regimens comes with the challenges of balancing toxicities and aligning a regimen with the biology of the myeloma and the nature of the relapse in conjunction with patient treatment history and personal preference. Herein, we provide an overview of treatment options for both early and late relapsing disease as well as a discussion of the role of emerging immune-based therapies.

Matching‐adjusted indirect comparison of isatuximab plus carfilzomib and dexamethasone with daratumumab plus lenalidomide and dexamethasone in relapsed multiple myeloma

“…In the current clinical practice, lenalidomide-based regimens, such as Dara-Rd, are considered the go-to regimen in the 2L + setting for patients with RRMM who experienced the rst relapse and are frequently used in non-lenalidomide-refractory patients until progression [22][23][24]. Immunotherapy drugs are being broadly used in the treatment of RRMM.…”

“…For optimum effect, doublet or triplet-based regimens are usually preferred over single agents for patients with RRMM [21]. In the 2L + setting, triple combination therapy with mAB + IMiD + dexamethasone, such as Dara-Rd is a go-to regimen for patients at rst relapse, and it is frequently used in non-lenalidomide-refractory patients until progression, whereas Isa-Kd is usually considered for lenalidomide-sensitive patients [23][24][25].…”

“…21 In the 2L+ setting, triple combination therapy with mAB + IMiD + dexamethasone, such as Dara-Rd is a go-to regimen for patients at first relapse, and it is frequently used in non-lenalidomide-refractory patients until progression, whereas Isa-Kd is usually considered for lenalidomide-refractory patients. [23][24][25] Despite advances in therapy with improved survival outcomes, MM remains largely incurable, with patients continuously relapsing over the course of the disease. 9,26,27 Over time, patients can become refractory or resistant to the existing therapies, that is, develop RRMM.…”

“…The choice of a treatment regimen for patients with RRMM depends upon several factors, such as response toward prior therapies, patient condition, expected effectiveness, and tolerability 21 . The current literature highlights that lenalidomide‐based regimens are frequently used in non‐lenalidomide‐refractory early relapse patients until progression in the second line (2L+) setting 22–24 . A Flatiron Health Database study revealed that lenalidomide‐based regimens are the most commonly used treatment option in patients with MM, as monotherapy or combination therapy (with PI or anti‐CD38 mAB), despite experiencing relapse on lenalidomide 22 .…”

Treatment of Multiple Myeloma in the First Relapse

“…Psychosocial issues and access to care are important in the relapsed setting, especially in older patients or with relapsed myeloma with comorbidities. Patients who have no access to transportation can be treated at home with oral treatment whenever possible [18].…”