Individualizing Treatment in Multiple Myeloma

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. They discuss the use of quadruplet therapy in fit and intermediate-fit patients up to 80 years of age, while emphasizing that treatment intensity should be adjusted when frailty, comorbidities, or treatment-related toxicity may limit tolerability. The experts describe practical approaches to de-escalating therapy, including reducing dexamethasone and modifying or discontinuing bortezomib when neuropathy or other adverse effects arise, while maintaining a daratumumab-based treatment strategy when appropriate. They emphasize the importance of avoiding excessive treatment intensity in patients who may be unable to tolerate a quadruplet regimen. The conversation then looks toward the future of frontline multiple myeloma treatment, including response-guided treatment modification, limited-duration strategies, and emerging combinations incorporating bispecific antibodies or cellular therapies. Dr. Usmani and Dr. Kumar discuss whether achieving comparable outcomes with shorter treatment duration could reduce treatment burden and potentially improve quality of life.