How I treat relapsed and/or refractory multiple myeloma

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• The therapeutic options for relapsed and/or refractory multiple myeloma (RRMM) have expanded significantly, improving patient outcomes.
• Established treatments include proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), monoclonal antibodies (mAbs), histone deacetylase inhibitors, and alkylating agents.
• Recent advancements include novel agents like selinexor and belantamab mafodotin, addressing unmet needs in triple-class refractory myeloma.

Purpose of the Study:

• To review the current treatment landscape for relapsed and/or refractory multiple myeloma (RRMM).
• To discuss a clinical approach for managing early and late-stage RRMM.
• To provide considerations for drug and combination sequencing in complex RRMM cases.

Main Methods:

• Review of current literature and clinical trial data on RRMM therapies.
• Analysis of treatment strategies based on drug classes and refractory status.
• Incorporation of clinical experience in managing RRMM patients.

Main Results:

• The expanding therapeutic landscape offers improved outcomes for RRMM patients.
• Novel agents address the unmet needs of patients refractory to standard therapies (triple-class refractory myeloma).
• Treatment selection and sequencing in RRMM have become increasingly complex.

Conclusions:

• A comprehensive approach integrating the latest data and clinical experience is crucial for optimizing RRMM treatment.
• Careful consideration of drug combinations and sequencing is necessary to navigate the evolving therapeutic options.
• Addressing triple-class refractory myeloma requires utilizing novel agents and tailored treatment strategies.