Treatment Recommendations for Relapsed Multiple Myeloma

CancerNetwork hosted a Training Academy focused on various treatment options for patients with relapsed multiple myeloma.

Management of Relapsed Multiple Myeloma

• With multiple treatments available, clinicians will determine the stage of relapse and provide the appropriate therapy.
  • Early relapse can be treated with combination therapies with the bases of these combinations including lenalidomide (Revlimid), pomalidomide (Pomalyst), or bortezomib (Velcade).
• Although triplet combinations are preferred, the treatment must be individualized to the patient based on patient preference, condition, and disease progression.
• For 1 to 3 lines of therapy, triplet combinations are available, including the following:
  • Carfilzomib (Krypolis), daratumumab (Darzalex), and dexamethasone
  • Daratumumab, pomalidomide, and dexamethasone
  • Bortezomib, selinexor (Xpovio), and dexamethasone
• However, their trial data have not been compared head-to-head.
• For late relapse, chimeric antigen receptor (CAR) T-cell therapy, B-cell maturation antigens, and bispecific therapies are available.
  • Immunotherapeutic options are also available.

Deciding Between CAR T-Cell and Bispecific Therapies

• Typically decisions are made based on access and availability of the product.
  • Each center has different availability of treatments or waiting-list times.
  • Of note, because these therapies are new, clinics and institutions are still transitioning.
• CAR T-cell therapy and bispecific treatments are optimally used as fourth-line therapy and beyond.

Step-Up Dosing of Teclistamab (Tecvayli)

• This can vary between institutions and community practices.
• Patients can be admitted as an inpatient, or treatment can be administered in an outpatient setting.
• The FDA requires patients to be admitted for 48 hours after administration to monitor for cytokine release syndrome.
• Step-up dosing is usually given on days 1, 4, and 7.