Multiple Myeloma

International Myeloma Foundation Chief Medical Office Joseph Mikhael, MD, shares how the M-Power initiative is addressing disparities through community engagement, education, and improved clinical trial access.

Patients with extramedullary disease had inferior progression-free survival.

Panelists discuss how recent updates from the phase 3 IsKia trial demonstrate that isatuximab combined with carfilzomib, lenalidomide, and dexamethasone improves minimal residual disease negativity rates by approximately 10% at both the 10–5 and 10–6 levels, particularly benefiting high-risk patients.

Panelists discuss how the PERSEUS trial’s subgroup analysis reinforced that sustained minimal residual disease negativity predicts better long-term outcomes and demonstrated the potential for treatment de-escalation at the 2-year mark, while other trials like Advance showed dramatic increases in MRD negativity rates with quadruplet therapy.

Following the FDA approval of linvoseltamab (Lynozyfic; Regeneron) for heavily pretreated multiple myeloma, Sundar Jagannath, MBBS, highlights its potential for earlier use, increased accessibility, and greater competition in the B-cell maturation antigen (BCMA) bispecific antibody space.

The newly FDA-approved linvoseltamab (Lynozyfic; Regeneron) may improve access to multiple myeloma treatment by offering an off-the-shelf, outpatient option that can be administered in community settings, according to Sundar Jagannath, MBBS.

Panelists discuss how emerging evidence from first-line therapy trials continues to demonstrate the superiority of quadruplet over triplet regimens, with the CEPHEUS subgroup analysis confirming that even higher-risk and less-fit patients can benefit from 4-drug combinations while maintaining acceptable safety profiles.

Panelists discuss how quality of life (QOL) and treatment convenience should be balanced with maximal depth of response through personalized therapy approaches, emphasizing the importance of multidisciplinary care teams and the flexibility to adapt treatment regimens based on individual patient preferences and circumstances.

A comprehensive US analysis showed that progress in multiple myeloma survival has not been shared equally, with significant disparities persisting despite improved therapies.

Panelists discuss how newer immune-based therapies and bispecific antibodies may enable fixed-duration treatment approaches that could eliminate the need for stem cell transplant in older but fit patients, potentially allowing for treatment-free intervals after achieving deep responses.

Panelists discuss how to balance achieving deeper MRD-negative responses against increased toxicity risks in transplant-ineligible patients by personalizing therapy through dose modifications, weekly vs twice-weekly dosing schedules, and careful monitoring while maintaining treatment intensity similar to clinical trials.

In part 2, Hans Lee, MD, shares practical tips for using linvoseltamab in heavily pretreated multiple myeloma and outlines trials that may expand its future role.

Panelists discuss how NCCN guidelines are expected to incorporate quadruplet-based regimens as reasonable treatment approaches for transplant-ineligible patients, while emphasizing the need for personalized treatment strategies that consider individual patient frailty and high-risk genetics rather than applying uniform approaches across all older patients.

Panelists discuss how the CEPHEUS trial demonstrated that quadruplet therapy (daratumumab, bortezomib, lenalidomide, and dexamethasone) significantly improved minimal residual disease negativity rates compared to triplet therapy in transplant-ineligible multiple myeloma patients, achieving approximately 60% vs 47% 10–5 responses while maintaining manageable safety profiles.

Tyler Sandahl, PharmD, a clinical pharmacist at Mayo Clinic, explains that sequencing novel multiple myeloma therapies with CAR T-cell therapy is generally prioritized first for eligible patients, while bispecific antibodies are reserved for later lines or for patients unable to tolerate CAR T.

Panelists discuss how emerging therapies like CAR T cells and bispecific antibodies may transform frontline treatment by potentially replacing transplant or changing induction regimens, while considering the cost implications and need for sustainable care models.

Panelists discuss how early relapse in standard-risk patients represents a failure of current risk assessment methods and may require advanced sequencing technologies to identify hidden high-risk features that traditional fluorescence in situ hybridization testing misses.

Tyler Sandahl, PharmD, a clinical pharmacist at Mayo Clinic, discussed the complexities of alternative payment models for chimeric antigen receptor T-cell and bispecific therapies and the need for improved data sharing in cancer care.

The findings contradict previous research suggesting high-risk patients with multiple myeloma were more likely to have a higher percentage of regulatory T cells (Tregs).

The FDA has removed Risk Evaluation and Mitigation Strategies (REMS) for approved chimeric antigen receptor (CAR) T-cell therapies for hematologic malignancies, aiming to ease provider burden and expand patient access.

Financial, family, and logistical challenges often lead patients to choose ongoing therapies over stem cell transplantation, says Mansi Shah, MD.

Disparities in multiple myeloma outcomes and the need for equitable care were the focus of 2 posters presented at the 2025 American Society of Clinical Oncology annual meeting.

Mansi Shah, MD, explains how treatment sequencing and patient eligibility guide the use of these therapies in multiple myeloma.

Panelists discuss how autologous stem cell transplant (ASCT) deferral should be approached cautiously with concrete medical reasons, as transplant continues to provide superior progression-free survival and potentially curative outcomes for a subset of patients.

Panelists discuss how maintenance therapy should be tailored based on risk profiles, with standard-risk patients receiving single-agent lenalidomide while high-risk patients may benefit from combination maintenance strategies to achieve more durable responses.