Saad Z. Usmani, MD, MBA, FACP

The faculty discuss how CAR T-cell therapy, bispecific antibodies, and an antibody-drug conjugate differ in infection management and in how often patients need to be seen. They review the restricted access program and the eye exam before dosing, and a short segment covers working with an optometrist or ophthalmologist, and how brief the exam and form are. The panel then looks ahead to dosing schedule evolution, earlier-line use, and patient convenience. The panel closes with key takeaways on the head-to-head DREAMM-7 results, ocular monitoring, differences between the trial and the label, and room for different options in practice depending on the patient.

The program concludes with panelists discussing what would improve deliverability of the regimen in the community.

The faculty consider how to apply belantamab mafodotin in community practice, where clinicians typically see fewer patients with myeloma and want clear guidance and quick decisions. They discuss the therapy options available to patients and how access and distance from an academic center may shape the choice. They note that antibody-drug conjugates are familiar from other cancers, such as solid tumors and lymphomas, and proceed to describe an approach of assessing response and eye side effects after the first doses and then delaying or spacing doses as needed if the patient is responding to treatment.

One panelist reassures a responding patient whose dose is held that benefit does not depend on every-3-week dosing and that the eye has the ability to heal on its own, noting that patients at longer intervals in the study maintained benefit, some doing better by staying on treatment longer.

The moderator and the panelists then discuss how to prepare the patient for the first cycles.

Dr. Saad Usmani and Dr. Shaji Kumar conclude the discussion by considering how the CEPHEUS findings may be applied to individual patients with newly diagnosed multiple myeloma.

Dr. Saad Usmani and Dr. Shaji Kumar discuss how sustained MRD negativity and long-term progression-free survival may inform future treatment strategies for patients with newly diagnosed multiple myeloma.

The faculty turn to the safety and practical aspects of using belantamab mafodotin, drawing on earlier experience with the drug. They discuss how lines of therapy are defined and whether the definition needs refinement, and how efficacy endpoints translate into clinical relevance. Health-related quality of life is reviewed, with the view that good disease control is a driver of better quality of life. The panel describes holding the drug for eye symptoms, restarting at a lower dose, and adjusting dosing frequency to keep responding patients on therapy. They also note the overall response rate and MRD negativity in the study and discuss their interpretation of the data.

The moderator asks whether any of the patient’s baseline comorbidities from the clinical scenario in the previous episode are a concern.

One panelist addresses neuropathy in a patient who has received bortezomib, describing a symptom-driven approach.

Dr. Saad Usmani and Dr. Shaji Kumar examine the CEPHEUS findings on response depth and durability in newly diagnosed multiple myeloma, with particular emphasis on MRD negativity and its potential implications for treatment duration.

Dr. Saad Usmani reviews the design of the phase 3 CEPHEUS study in patients with transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma, highlighting the importance of patient fitness and age in defining the study population.

The faculty discuss the DREAMM-7 eligibility and exclusion criteria, including the exclusion of patients refractory to daratumumab or bortezomib. They consider how well the trial population reflects patients seen in practice, given limited prior anti-CD38 exposure. The conversation then turns to the enrolled population vs the approved indication of at least 2 prior lines, which was based on a subgroup. Finally, the faculty share their views on that restriction and discuss the survival benefit seen in the study.

Experts explain how myeloma regimens manage eye toxicity with baseline exams, dose holds, reductions, and longer belantamab dosing intervals to improve safety.

Practical guidance for starting belantamab: confirm eligibility, coordinate ophthalmology exams, manage reversible eye toxicity with dose holds, and educate patients for confident dosing.

Dr. Thomas Martin presents the final and most challenging case: an older patient being evaluated for BCMA-directed therapy after progression on prior anti-CD38 therapy, with baseline neuropathy, mild gait instability, recurrent infections, and significant caregiver concern about neurologic toxicity, infection, and logistics.

Dr. Thomas Martin presents the second case: a younger, fit, lenalidomide-refractory patient with biochemical and radiologic progression after frontline therapy who is relatively asymptomatic with controlled disease burden and is an appropriate candidate for either CAR T-cell or bispecific therapy, with no urgency to treat.

Dr. Thomas Martin introduces the third section, a rapid case-based discussion applying the program's themes to real-world scenarios, and presents the first case: a fit, transplant-exposed patient progressing on lenalidomide maintenance with rapidly progressive, symptomatic, high-risk disease requiring prompt intervention.

The face-off debate continues with the second and third questions, moderated by Dr. Thomas Martin.

Dr. Thomas Martin opens the second section, the face-off debate, and introduces the first debate question on how clinicians should approach treatment selection between CAR T-cell therapy and bispecific antibody-based approaches in second-line disease.

Team Myeloma Mavericks presents the sixth abstract review, a real-world and safety-focused discussion of BCMA-directed therapies in earlier-relapse disease, closing out the data-and-landscape section.

Team Myeloma Mavericks presents the fifth abstract review, the updated long-term analysis of CARTITUDE-4 evaluating ciltacabtagene autoleucel against standard triplet therapy in earlier-relapse disease, framed by the durable remissions and cure signal seen in longer-term CARTITUDE-1 follow-up.

Dr. Thomas Martin introduces the fourth abstract review, and Team Myeloma Masters presents MajesTEC-9, the phase 3 study of teclistamab monotherapy versus investigator's choice of standard, non-CD38-containing regimens in patients who are both lenalidomide- and anti-CD38-refractory after prior lines of therapy.

Dr. Thomas Martin transitions the panel to the third abstract review, and Team Myeloma Masters presents real-world treatment patterns and outcomes in lenalidomide-refractory relapsed/refractory multiple myeloma drawn from the Flatiron registry.

Segment opens with the closing moments of the CAR T-cell therapy quality-of-life argument before Dr. Thomas Martin transitions to the second abstract review.

DREAMM-7 reveals belantamab combo extends myeloma PFS, with reversible eye effects, REMS monitoring, and fewer severe infections.

Dr. Saad Usmani and Dr. Shaji Kumar discuss how treatment goals and measures of clinical benefit have evolved in newly diagnosed multiple myeloma.

Dr. Saad Usmani and Dr. Shaji Kumar introduce the evolving treatment landscape for newly diagnosed multiple myeloma, focusing on the increasing role of CD38-directed therapy in frontline treatment.

Experts explain who benefits from belantamab in relapsed myeloma and how REMS eye exams and dose tweaks keep treatment on track.

The faculty describe the approval of belantamab mafodotin with bortezomib and dexamethasone for patients who have had at least 2 prior lines of treatment including a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD), noting the boxed warning for ocular adverse effects.