Case-Based Sequencing Decisions in Early Relapse Multiple Myeloma

In this case-based segment on early relapse multiple myeloma, Luciano Costa introduces a 58-year-old, transplant-eligible patient with standard-risk cytogenetics who relapses 3.5 years after frontline quadruplet therapy and maintenance. Muhamed Baljevic discusses how this clinical scenario reflects a common but nuanced decision point in practice. He notes that although the remission duration is meaningful, it may still be considered somewhat shorter than expected with modern regimens, prompting consideration of more effective second-line strategies. Dr. Baljevic highlights strong evidence supporting early use of CAR-T therapy, particularly in standard-risk patients, while also acknowledging that patient preference and logistical factors may influence decision-making. He further explains that BCMA-directed bispecific antibody combinations, such as those evaluated in phase 3 studies, represent a viable alternative, especially in anti-CD38–exposed but non-refractory patients. The discussion emphasizes individualized sequencing, balancing efficacy, safety, treatment goals, and patient preference in multiple myeloma.