Sequencing BCMA Therapies and Identifying the Right Patient: Treatment Selection and Access Considerations in Relapsed/Refractory Multiple Myeloma

In “Sequencing BCMA Therapies and Identifying the Right Patient: Treatment Selection and Access Considerations in Relapsed/Refractory Multiple Myeloma,” the expert oncologists and oncology pharmacists explore the following questions:

• How would you discuss the sequencing of these therapies, and which patient factors go into treatment selection?
• How does the absence of step-up dosing or hospitalization requirements affect the appeal of certain B-cell maturation antigen (BCMA)-targeted therapies?
• Which patients are you using belantamab mafodotin for, and which patients are not appropriate candidates?

Zahra Mahmoudjafari, PharmD, emphasizes that treatment sequencing in relapsed/refractory multiple myeloma (RRMM) must be highly individualized, taking into account prior BCMA exposure, disease burden, caregiver support, logistical factors, comorbidities, and institutional access to specific therapies such as CAR T-cell therapy. She notes that although a standardized algorithm would be ideal, the complexity of the disease and evolving evidence base make a one-size-fits-all approach impractical. Al-Ola Abdallah, MD, highlights that the absence of step-up dosing requirements and less frequent administration schedules make belantamab mafodotin particularly appealing for patients with significant comorbidities such as congestive heart failure, liver failure, or end-stage renal disease, as well as for those living far from treatment centers or lacking adequate caregiver support for CAR T-cell therapy. Anjulie Quick, MD, added that there are no absolute contraindications to belantamab mafodotin from an ocular standpoint, though patients with preexisting severe dry eye or corneal epithelial disease should have those conditions optimized before initiating treatment, and that dose modifications, rather than discontinuation, remain the preferred approach for patients who develop significant keratopathy.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, “Bridging the Gap: Community-Based Administration and Access Barriers for BCMA-Targeted Therapies in Multiple Myeloma,” panelists continue their discussion on RRMM and highlight which patient populations are best suited for community-based administration of BCMA-targeted therapies, the future of community administration, why immediate access to these therapies is essential, and the pain points that remain with currently approved agents.