Navigating Myeloma’s Crowded Treatment Frontier: Swarup Kumar, MD

Swarup Kumar, MD, assistant professor of medicine in the Division of Hematology and Medical Oncology at UConn Health and a leader of its multiple myeloma (MM) and plasma cell disorders program, discussed the practical and clinical challenges of treating hematologic malignancies in nontraditional and rapidly evolving treatment settings.

Kumar described his 3 years working in a Department of Corrections oncology clinic early in his faculty career, an experience he called rewarding both for mentoring fellows and for managing a patient population with distinct logistical and medical needs. He noted that his team has administered bispecific antibody therapy to an incarcerated patient, emphasizing that such treatment is achievable with sufficient planning, coordination with authorities, and hospital-based administration for early doses. He added that bispecific antibodies offer a practical advantage, because once patients respond well, treatment intervals can often be extended safely from every 2 weeks to monthly or even every 8 weeks, reducing infection risk and hypogammaglobulinemia while preserving response.

Turning to the broader relapsed/refractory myeloma landscape, Kumar said the proliferation of bispecific antibodies, chimeric antigen receptor (CAR) T-cell therapy, and antibody-drug conjugates (ADCs) is a welcome development but requires a shift in mindset, from managing myeloma as a chronic disease to pursuing the therapy most likely to produce deep remission or cure. His framework weighs age, comorbidities, and functional status: an older patient with significant comorbidities may not be a candidate for aggressive, potentially curative therapy if it risks quality of life, while a younger, highly functional patient may be steered toward more robust, fixed-duration treatment aimed at cure. Clinical trial participation is also a first consideration whenever a patient's profile fits an available research portfolio.

Among approved options, Kumar said he generally favors bispecific antibodies over ADCs given more robust data and industry momentum toward fixed-duration regimens with high minimal residual disease–negativity rates, particularly for older patients with aggressive disease needing rapid control. UConn does not yet offer CAR T-cell therapy on site but partners with nearby centers, with in-house capability expected soon. He reserves ADCs, such as belimumab, largely for patients who have not responded to CAR T-cell therapy or bispecifics, citing manageable but notable ocular toxicity monitored with ophthalmology support.