Dr. Martin on Treating First Relapse in Multiple Myeloma

Thomas G. Martin, MD, clinical professor of medicine, Adult Leukemia and Bone Marrow Transplantation Program, associate director, Myeloma Program, University of California, San Francisco, and co-leader, Hematopoietic Malignancies Program, Helen Diller Family Comprehensive Cancer Center, discusses the management of first relapse in patients with multiple myeloma.

Many patients receive lenalidomide (Revlimid) maintenance after frontline treatment. If patients are still on lenalidomide when they have their first relapse, regimens that have shown a benefit in lenalidomide-refractory patients should be selected, says Martin. Conversely, patients who are not on lenalidomide when they relapse could take a regimen that contains lenalidomide.

Patients in first relapse are still able to achieve deep second remissions and prolonged progression-free survival. As such, patients should be treated as aggressively as possible to increase their chances of achieving such responses, says Martin.

Typically, patients will receive a triple regimen that consists of an immunomodulatory drug, a proteasome inhibitor, and a monoclonal antibody. If patients are sensitive to lenalidomide, they could receive the combination of daratumumab (Darzalex), lenalidomide, and dexamethasone. If patients are refractory to lenalidomide, lenalidomide is generally replaced with either pomalidomide (Pomalyst) or carfilzomib (Kyprolis), concludes Martin.