Current Treatment Strategies for Multiple Myeloma at First Relapse

Area of Science:

• Hematologic Oncology
• Cancer Therapeutics
• Clinical Practice Guidelines

Background:

• Multiple myeloma (MM) is an incurable hematologic cancer with a pattern of relapse after initial treatment.
• Treatment effectiveness diminishes with each relapse, making the first relapse a critical point for therapeutic decisions.
• Emergence of refractoriness to key drug classes presents a significant challenge in managing relapsed MM.

Purpose of the Study:

• To provide clinicians with evidence-based strategies for managing first-relapse multiple myeloma.
• To review emerging therapeutic options and guide personalized treatment selection.
• To address the complexity of the evolving treatment landscape in relapsed MM.

Main Methods:

• Review of current clinical practice guidelines and therapeutic strategies for first-relapse MM.
• Consolidation of evidence on established triplet regimens (carfilzomib, pomalidomide, selinexor).
• Evaluation of emerging therapies, including chimeric antigen receptor T-cell (Cilta-cel) therapy.

Main Results:

• Triplet regimens remain a cornerstone for first-relapse MM, with optimal combinations depending on prior drug resistance and patient factors.
• Chimeric antigen receptor T-cell therapy shows promise for long-term remissions but faces accessibility challenges.
• Personalized treatment selection is crucial, considering disease biology, prior therapies (especially anti-CD38 antibodies and lenalidomide), and comorbidities.

Conclusions:

• Optimal management of first-relapse MM requires careful consideration of individual patient factors and prior treatment history.
• A combination of established triplet regimens and novel therapies like CAR T-cells offers improved outcomes.
• This review provides a framework for clinicians to navigate complex treatment decisions in relapsed multiple myeloma.