First Relapse in Multiple Myeloma: Balancing Options, Sequencing Decisions, and Patient-Centered Care

In this episode, 'First Relapse in Multiple Myeloma: Balancing Options, Sequencing Decisions, and Patient-Centered Care,' the experts explore the following questions:

1. The second-line multiple myeloma space is becoming increasingly crowded with new and anticipated approvals. How are you currently approaching treatment selection at first relapse, and how has that decision-making process changed in recent years?
2. With so many options now available or anticipated in the second-line space, how are you thinking about sequencing across lines of therapy?
3. Do you think the field needs clearer sequencing guidelines, or does the current framework allow for more flexibility for complex patients?

The panelists examined how treatment selection at first relapse has grown significantly more complex in recent years, with the approach now beginning with a careful assessment of what the patient was receiving at the time of relapse before moving into a shared decision-making conversation that incorporates patient goals, lifestyle considerations, and preferences around CAR-T, bispecific antibodies, or oral combination regimens. The discussion also explored how the MAJESTEC-3 data for teclistamab is prompting clinicians to reconsider the automatic reflex toward CAR-T referral at first relapse, particularly for patients who face logistical, social, or occupational barriers to the month-long commitment that CAR-T therapy requires, and for those in whom the toxicity profile of bispecific antibodies may represent a more manageable alternative. The panelists also addressed whether the field needs clearer sequencing guidelines, arriving at a nuanced consensus that while standardized frameworks would be valuable, the flexibility of the current landscape is equally important given that no two patients present identically, and that the ultimate determinant of optimal sequencing will likely only become clear once the field has greater clarity on where bispecific antibodies and novel frontline combinations will ultimately land in the treatment algorithm.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Refractory vs. Exposed: How Anti-CD38 Status Shapes Second-Line Treatment Decisions in Multiple Myeloma,' features the panelists advancing their conversation on multiple myeloma and focusing on how clinicians define anti-CD38 refractoriness versus prior exposure in practice, how this distinction shapes second-line treatment selection, and what emerging trial data may mean for the future use of bispecific antibodies in patients who have received anti-CD38 therapy in the frontline setting.