Relapsed/Refractory Multiple Myeloma: Real-World Treatment Patterns, Attrition, and the Case for Earlier BCMA-Directed 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. The review highlights the predominance of doublet and triplet regimens irrespective of prior lines of therapy, limited uptake of NCCN-preferred regimens, a short real-world median progression-free survival relative to clinical trial data, and high patient attrition across subsequent lines of therapy. Dr. Martin then opens the floor on the timing of BCMA-directed therapy in relapse, prompting when clinicians and the community should refer patients for CAR T-cell therapy or a bispecific antibody. The segment closes on a clear point of cross-team consensus, with both teams agreeing that BCMA-directed therapy should be moved to first relapse and delivered at second line, citing consistent progression-free and overall survival advantages over prior triplet standards of care and the imperative to give patients the most effective therapies before attrition removes the opportunity.