Risk Stratification and Shared Decision-Making in Early Relapse Multiple Myeloma

In this segment on early relapse multiple myeloma, Luciano Costa and Carol Ann Huff explore how timing of relapse influences risk assessment and treatment decision-making. Dr. Huff explains that relapse closer to transplant or early during maintenance is generally associated with higher-risk disease biology, whereas longer remission durations suggest more favorable disease behavior. She emphasizes that current evidence does not definitively establish the optimal sequencing of CAR-T therapy and BCMA-directed bispecific antibodies, noting that available data are influenced by trial design and patient selection rather than direct comparisons. Both panelists highlight that emerging phase 3 data challenge the perception that bispecific antibodies are inherently less effective than cellular therapies in earlier lines. Instead, treatment selection increasingly relies on shared decision-making, incorporating patient preferences, lifestyle considerations, and tolerance for risk. Overall, this discussion reinforces that in multiple myeloma, sequencing decisions are evolving and should be individualized based on both clinical factors and patient priorities.