Updates in Sequencing Treatment for Early Multiple Myeloma Relapse

Presenter Maria-Victoria Mateos, MD, PhD, University Hospital of Salamanca-IBSAL, Salamanca, Spain, discussed how optimal sequencing in MM has changed from those outlined in the older EU guidelines.

The future landscape of multiple myeloma (MM) depends on the type of relapse, as each combination therapy can be specific to a certain set of patients, according to a presentation at the Society of Hematologic Oncology (SOHO) 2021 Annual Meeting.

Presenter Maria-Victoria Mateos, MD, PhD, University Hospital of Salamanca-IBSAL, Salamanca, Spain, discussed how optimal sequencing in MM has changed from those outlined in the older EU guidelines. The new guidelines for relapsed/refractory MM (RRMM) are modeled around CD38-based and non-CD38-based regimens, according to Mateos.

“The new response criteria are applicable to all patients,” Mateos added.

Mateos further detailed different studies that analyzed treatments using carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone; isatuximab plus carfilzomib-dex in patients with RRMM; and daratumumab plus carfilzomib (Kyprolis) and dexamethasone in lenalidomide-refractory patients with multiple myeloma.

While examining all of the options, the best way to pick between the different combinations is by the duration of treatment with lenalidomide, comorbidities, and lifestyle of the patient, according to Mateos.

“Optimal sequencing treatment is at relapse, when the majority of patients receive lenalidomide as a part of first-line therapy and progress while on lenalidomide,” Mateos said.

Even with the new guidelines in place, Mateos still feels that new combinations are needed for this population of patients, as many of the treatments are selected after being exposed to proteasome inhibitors, immunomodulatory imide agents, and anti-CD38 during the first- and second-line of therapy. Further, new options are emerging for early relapses.

“[Pomalidomide, bortezomib, and dexamethasone] is most solid combination from my point of view for these patients, with Selinexor dexamethasone also being promising, ” Mateos added.

REFERENCE

Mateos MV. Sequencing Treatment for Early Relapse: Which Triplets and When? Presented at: the Society of Hematologic Oncology (SOHO) 2021 Annual Meeting; virtual. September 9, 2021. Accessed September 14, 2021.