Although therapeutic advances in multiple myeloma have improved patient outcomes, this has generated a wide range of patient profiles at early relapse.

Dr Elena Zamagni summarises the unmet medical needs in earlier relapses in multiple myeloma, including: 

• The current treatment landscape and challenges 

• Current guidelines and recommendations 

• The need for new targets/therapies with different mechanisms of actions 

Clinical takeaways

• Current guidelines recommend lenalidomide-based treatment in the frontline setting
• Non-transplant eligible patients may become anti-CD38 refractory after one prior line of therapy
• Although therapeutic advances in MM have improved outcomes, this has generated a wide range of patient profiles at early relapse, many with substantial unmet needs
• There is a need for new targets/new drugs with different mechanisms of action
• SVd may be a suitable treatment option for early relapsed patients previously treated with lenalidomide and daratumumab, as it offers a double MoA switch

The world of multiple myeloma has changed considerably over the last several years and, in particular, in early relapse. There are more treatment options than ever before.

Dr Joseph Mikhael discusses current best practices in treating patients with multiple myeloma in the early relapsed/refractory setting and explores:

• Different treatment sequences, combinations and dosing in multiple myeloma

• His experience with XPO1 inhibitors and his approach to managing side effects

Clinical takeaways

• The treatment landscape for early relapsed multiple myeloma is expanding, including CAR-T cell therapies now available (prioritised for functional high-risk patients)
• Early relapse management involves several drug classes:
  • Immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, XPO1 inhibitors
• Selinexor is a first-in-class XPO1 inhibitor. Side effects can be managed through dose modifications and with the use of antiemetics
• General principles of therapy selection include:
  • Introducing a new mechanism of action
  • Using a triplet combination
  • Selecting the best combination based on patient, disease and treatment characteristics