Dr. Bergsagel on Competing Philosophies of Treatment in Patients With Relapsed Myeloma

Leif Bergsagel, MD, consultant and professor of medicine, Division of Hematology/Oncology, Mayo Clinic, discusses competing strategies in treating patients with relapsed multiple myeloma.

There are 2 philosophies for treating relapsed multiple myeloma, says Bergsagel. Physicians can gradually introduce 1 drug and then a second. A patient may relapse on lenalidomide (Revlimid) and be given dexamethasone and subsequent ixazomib (Ninlaro). Physicians may choose to follow that with a more aggressive drug like carfilzomib (Kyprolis). If that fails, physicians may pursue daratumumab (Darzalex). That is the incremental approach, says Bergsagel.

If a patient progresses on lenalidomide, the alternative approach would be to completely switch to something else like carfilzomib with cyclophosphamide. In different situations, each of those approaches may be appropriate depending on how the patient is doing, concludes Bergsagel.