Dr. Kumar on Treatment Selection Considerations in Multiple Myeloma

Shaji K. Kumar, MD, a consultant in the Division of Hematology and a professor of medicine with Mayo Clinic, discusses treatment selection considerations in multiple myeloma.

Determining the optimal treatment for patients with multiple myeloma who experience early relapse is an area of ongoing research, says Kumar. Currently, in the frontline setting, patients who are eligible for autologous stem cell transplant (ASCT) typically receive a triplet induction regimen, followed by ASCT and lenalidomide (Revlimid) maintenance, Kumar explains. Patients who are ineligible for ASCT will often receive continuous treatment with a lenalidomide-containing combination until disease progression, Kumar says.

As such, the majority of patients are refractory to lenalidomide at first relapse, Kumar explains. Consequently, lenalidomide is typically omitted from relapsed/refractory therapy options.

Additionally, treatment selection for subsequent relapses is largely dependent on what other regimens the patient has received, what drugs or combinations they are refractory to, and how they tolerated previous therapies, concludes Kumar.