Therapy Selection and Management Strategies for Transplant-Ineligible Older Patients

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

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

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

Newer immune-based therapies including T-cell engagers and bispecific antibodies are being integrated into frontline multiple myeloma treatment, potentially creating nonchemotherapy treatment paradigms. The concept of alternating triplet regimens targeting different resistance mechanisms represents an innovative approach to maximize therapeutic impact while minimizing cumulative toxicity. Fixed-duration therapy strategies are particularly attractive for older patients, offering the potential for treatment-free intervals after achieving deep responses.

Consolidation strategies using bispecific antibodies for patients with persistent disease after initial quadruplet therapy are being investigated to deepen responses and overcome resistance. The discussion of sequential treatment approaches emphasizes leveraging unique mechanisms of action to address different resistance patterns. These emerging strategies aim to achieve sustained minimal residual disease (MRD) negativity while allowing for treatment breaks and quality of life improvements.

Clinical implementation of emerging therapies requires careful patient selection, with considerations for treatment sequencing and optimal timing of novel agents. The potential for fixed-duration therapy represents a paradigm shift from continuous treatment models, which is particularly relevant for transplant-ineligible patients. Future directions include personalized treatment approaches based on genetic risk stratification, MRD monitoring for treatment guidance, and integration of cellular therapies into earlier treatment lines for optimal outcomes.