Relapsed/refractory multiple myeloma: standard of care management of patients in the Gulf region.

Abstract

Clinical management of patients with relapsed/refractory multiple myeloma (RRMM) can be challenging, whereby each relapse is associated with progressively poorer outcomes. In addition, changes in disease biology and patient characteristics hamper treatment strategies in this setting, as do toxicities accumulated across previous lines of therapy. The availability of several new treatment classes has brought about improvements in outcomes, but with median survival in the RRMM setting at only ~32 months, a review of current standard of care treatments and considerations for optimizing care in this setting is warranted. Here, we discuss our preferred approach to treating patients with RRMM, based on our collective experience across the Gulf region. We present position statements for the treatment of lenalidomide-sensitive and -refractory patients, as well as for those patients experiencing late relapse. We discuss the major impact that anti-CD38 agents daratumumab and isatuximab have had on the management of RRMM, which is reflected in our preferred use of daratumumab-based regimens across the lenalidomide-sensitive and -refractory settings. For late-relapse settings, we discuss how bispecific antibodies and chimeric antigen receptor [CAR]-T cells are among the biggest breakthroughs in recent years, achieving excellent responses in triple-class exposed patients. While the use of these agents is not yet widespread in the Gulf region, we advocate their use where available and discuss strategies to manage and minimize common toxicities and adverse events associated with their use.