Management of Early Relapse, How to Navigate the Choices

Abstract

Treatment of relapsed and/or refractory multiple myeloma (RRMM) is always a challenge for the hematologist. Over the last 5 years, a spectrum of novel therapies with different mechanisms of action, including second generation proteasome inhibitors (carfilzomib and ixazomib), third-generation immunomodulatory drugs (pomalidomide), a histone deacetylase inhibitor (panobinostat) and monoclonal antibodies (mAbs) (elotuzumab and daratumumab) has transformed our approach to the treatment of patients with RRMM. This paper reports on the treatment choices of early relapses with a specific focus on recent phase 3 trials of triplet combinations in this setting and the rationale behind the selection of one regimen over another. Several recent phase III trials, which included patients with RRMM, who were treated with 1-3 prior lines of therapy, have demonstrated that triplet combinations are associated with a deeper response and an increased duration of response compared to standard regimens. However, they have distinct toxicity profiles, which need to be taken into account by patients and physicians. The landscape of RRMM is changing rapidly, and new standards of care are proposed.