Treatment of Relapsed or Refractory Multiple Myeloma After Two or More Prior Lines of Therapy
Clinical scenario
This protocol applies to patients with relapsed and/or refractory multiple myeloma who have received two or more prior lines of therapy and have been exposed to — or are refractory to — a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 antibody. This includes the subset with triple-class refractory disease.
Treatment approach
The guiding principle in this setting is to select from agents not previously administered. Options span cellular immunotherapy strategies and novel combination regimens, with a distinct set of approaches reserved for patients whose disease has become refractory to all three prior drug classes. The complete treatment algorithm — covering agent selection, sequencing, and eligibility criteria — is available in the full structured protocol.
References
DOI: 10.1038/s41571-025-01041-x
- In the third or fourth line of treatment, patients can receive treatments that they have not been previously exposed to, including cilta-cel, ide-cel, BelaPd, DaraPd, IsaPd, EloPd, BelaVd [I, A] or other regimens (Fig. 3).
- Patients with triple-class refractory MM can receive cilta-cel or ide-cel in the third or fourth lines of treatment [I, A] or in the fifth line and beyond [II, B], teclistamab [II, B], elranatamab [II, B], linvoseltamab [II, B], talquetamab [II, B] or BelaPd [I, A].
- These patients can also receive melflufen if they had not previously undergone ASCT or if the time to disease progression after ASCT is ≥3 years [I, B].
- Seld is another option in these patients [II, B].
View source ↗