Frontline management of multiple myeloma patients: optimizing treatment for patients in the Gulf region

Treatment options for newly diagnosed multiple myeloma (NDMM) have expanded dramatically over the last two decades, resulting in remarkable improvements in response rates and median survival times. In eligible patients, autologous stem cell transplant plays the central role of an overall treatment strategy comprising induction, transplantation, consolidation, and maintenance. In this article, we draw from our own collective clinical experience of treating patients with NDMM in the Gulf region to discuss treatment strategies in both transplant-eligible and -ineligible patients, as well as in high-risk patients. We present position statements for these distinct patient populations specifically for treatment in the Gulf region, where patients with NDMM have a younger median age than and different comorbidity profile from Western populations. We discuss how the introduction of anti-CD38 agents, including daratumumab and isatuximab, have had a major impact on the frontline treatment landscape in MM, with daratumumab-based quadruplet and triplet regimens emerging as the new standard of care in transplant-eligible and -ineligible patients, respectively. In addition, we advocate aggressive quadruplet treatment of high-risk patients with NDMM, as part of a strategy including single or tandem transplant when eligible. Finally, we discuss the clinical and practical rationale behind our statements, which is intended to serve as a useful reference for hematologists treating physicians within the Gulf region and beyond.