Defining Early Relapse and Treatment Selection in Multiple Myeloma

In this opening segment on early relapse multiple myeloma, Luciano Costa frames the evolving treatment landscape, highlighting how frontline quadruplet regimens and maintenance strategies have shifted expectations around remission duration and disease biology. Carol Ann Huff discusses how “early relapse” is now often considered within approximately 3 to 4 years post-transplant in the modern era, reflecting both improved outcomes and the identification of patients with biologically aggressive disease. She emphasizes the importance of distinguishing between prior exposure and true refractoriness, noting that progression on therapy, particularly lenalidomide maintenance or anti-CD38–based regimens, has significant implications for subsequent treatment selection. The discussion also highlights the need to avoid reusing ineffective agents and supports the use of combination approaches in the relapsed setting. Together, the panel establishes a clinically relevant framework for defining early relapse multiple myeloma and guiding therapy decisions in contemporary practice.