Balancing Deeper Response and MRD Negativity With Toxicity Risks in Clinical Decision-Making

EP: 1.Treatment Approaches and Goals: Transplant-Eligible vs. Transplant-Ineligible Patients

EP: 2.The Role of ASCT in Frontline Myeloma: Comparative Risks and Benefits with Other Standard Treatment Approaches

EP: 3.Evaluating First-Line Treatment Options: Quadruplet vs Triplet Regimens and NCCN Guidelines

EP: 4.The Role of MRD Status in Post-ASCT Treatment Decisions and Clinical Integration

EP: 5.Tailoring Maintenance Therapy by Patient Risk: Lenalidomide Alone vs Combination Approaches

EP: 6.Balancing Timing of ASCT: Insights on Delayed Transplantation and Long-Term Treatment Outcomes

EP: 7.Managing Early Relapse in Transplant-Eligible MM and the Influence of Clonal Evolution

EP: 8.Advancing Frontline Therapy in Transplant-Eligible Myeloma and Emerging Trends in Smoldering Myeloma Management

EP: 9.Evolving Treatment Strategies in Transplant-Ineligible NDMM: Expert Insights From CEPHEUS, IMROZ and BENEFIT

EP: 10.Navigating First-Line Therapy Guidelines and Treatment Considerations in High-Risk Cytogenetics

Now Viewing

EP: 11.Balancing Deeper Response and MRD Negativity With Toxicity Risks in Clinical Decision-Making

EP: 12.Therapy Selection and Management Strategies for Transplant-Ineligible Older Patients

Achieving deeper responses and minimal residual disease negativity must be carefully balanced against potential toxicity risks, particularly in transplant-ineligible patients who require long-term treatment sustainability. Key toxicity considerations include peripheral neuropathy from proteasome inhibitors, hematologic toxicity from immunomodulatory drugs, and infection risks from prolonged immunosuppression. Treatment personalization involves dose modifications, schedule adjustments, and careful patient selection to optimize outcomes while maintaining quality of life.

Practical approaches to toxicity management include transitioning from twice-weekly to once-weekly bortezomib dosing, reducing lenalidomide doses in older patients, and implementing proactive infection prevention strategies. The fit versus frail patient paradigm requires different treatment philosophies: aggressive initial treatment with dose reductions as needed for fit patients, versus gradual dose escalation for frail patients to avoid treatment abandonment. Multidisciplinary care teams including pharmacists, nurses, and specialists are essential for successful treatment completion.

Patient education and prompt intervention for complications remain critical for treatment success, particularly regarding infection recognition and management. The discussion emphasizes that treatment modifications should maintain similarity to clinical trial regimens while accommodating individual patient needs. Long-term treatment sustainability requires ongoing assessment of treatment burden, with consideration for dose reductions or drug discontinuation after achieving sustained responses, especially in patients maintaining prolonged MRD negativity.