Managing Comorbid Patients in Early Relapse Multiple Myeloma

In this segment on early relapse multiple myeloma, Luciano Costa presents a case of a 72-year-old patient with cardiovascular comorbidities and reduced fitness following prior transplant, raising important considerations for treatment selection. Muhamed Baljevic discusses how early relapse with lenalidomide-refractory disease suggests higher-risk biology, while comorbidities may limit eligibility for CAR-T therapy. He highlights that BCMA-directed bispecific antibodies remain a viable option in this setting, with careful attention to safety mitigation strategies such as inpatient monitoring during step-up dosing for higher-risk patients and proactive management of cytokine release syndrome and infections. Dr. Baljevic also notes that cardiovascular risk may influence avoidance of certain proteasome inhibitor–based regimens, prompting consideration of alternative combinations or even oral regimens based on patient preference. Overall, this discussion emphasizes individualized treatment selection in multiple myeloma, balancing disease risk, comorbidities, safety considerations, and patient preferences.