Key Factors for Therapy Choice in Relapsed/Refractory Multiple Myeloma

Prerna Mewawalla, MD, a hematologist at Allegheny Health Network, discusses how she approaches the choice of therapy for relapsed/refractory multiple myeloma now that many different options are available for patients.

Mewawalla says she bases her choice of therapy on 3 factors. The first is what therapies they have previously received and are refractory to, which could influence the option to use another drug in a class such as a proteasome inhibitor (PI) or anti-CD38 antibody.

She also considers what comorbidities patients have and the level of toxicity that they can tolerate. Some agents are significantly toxic and patients have already undergone combination therapy in earlier lines. Finally, she will look for particular genetic alterations, such as translocation (11;14), which was associated with antimyeloma response with venetoclax (Venclexta).

In patients who are relapsed/refractory after multiple lines of therapy, they are eligible for chimeric antigen receptor (CAR) T-cell therapy or bispecific agents such as teclistamab (Tecvayli), which Mewawalla says has led to positive results for her heavily pretreated patients.

TRANSCRIPTION:

0:08 | In the relapsed/refractory setting, I generally choose my treatments based on 3 different things. First, what have they already been on—so what are the refractory to? Are they [lenalidomide (Revlimid)]-refractory? Are they PI-refractory or are they anti-CD38-refractory? Then, I decide what treatment to use. I also base it on what their comorbidities are and what they can tolerate. The third thing I base it on is if they have any unique genetic mutations such as translocation (11;14), in which cases I can use venetoclax [Venclexta]. It's a unique population where you can use venetoclax, and that's how I decide what to do in my relapsed/refractory population early on. After they've been through a lot of these agents and they come to a point where they either can get a bispecific [antibodies] or CAR T-[cell therapy]. Because of access to CAR T, I have been using the teclistamab earlier on, and so far, have had positive results with that.