Advancing Frontline Therapy in Transplant-Eligible Myeloma and Emerging Trends in Smoldering Myeloma Management

EP: 1.Treatment Approaches and Goals: Transplant-Eligible vs. Transplant-Ineligible Patients

EP: 2.The Role of ASCT in Frontline Myeloma: Comparative Risks and Benefits with Other Standard Treatment Approaches

EP: 3.Evaluating First-Line Treatment Options: Quadruplet vs Triplet Regimens and NCCN Guidelines

EP: 4.The Role of MRD Status in Post-ASCT Treatment Decisions and Clinical Integration

EP: 5.Tailoring Maintenance Therapy by Patient Risk: Lenalidomide Alone vs Combination Approaches

EP: 6.Balancing Timing of ASCT: Insights on Delayed Transplantation and Long-Term Treatment Outcomes

EP: 7.Managing Early Relapse in Transplant-Eligible MM and the Influence of Clonal Evolution

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EP: 8.Advancing Frontline Therapy in Transplant-Eligible Myeloma and Emerging Trends in Smoldering Myeloma Management

This segment explores emerging therapies and strategies on the horizon for frontline treatment of transplant-eligible multiple myeloma patients and discusses how these innovations will transform the treatment landscape. The discussion divides emerging approaches into 2 main categories: CAR T-cell therapies and bispecific antibodies. CAR T therapies present the intriguing possibility of replacing autologous transplant, with ongoing clinical trials investigating this approach in both newly diagnosed settings and first/third relapse scenarios, potentially revolutionizing the treatment paradigm.

Bispecific antibodies offer opportunities to modify induction therapy by incorporating anti–B-cell maturation antigen agents either as monotherapy or in combination with anti-CD38 antibodies or immunomodulatory drugs. These approaches raise questions about optimal sequencing and combination strategies, including potential consolidation periods following transplant or CAR T therapy. The challenge lies in integrating these effective but mechanistically different agents into existing treatment frameworks while maintaining safety and deliverability standards established with current 4-drug regimens.

The implementation of these emerging therapies requires careful consideration of safety profiles, cost implications, and health care delivery models. While current quadruple regimens offer predictable toxicity profiles and ease of delivery, bispecific antibodies and cellular therapies introduce new adverse effect patterns, particularly infection risks, that must be understood before frontline implementation. The discussion emphasizes the need for sustainable treatment models that can accommodate higher upfront costs while potentially reducing long-term expenses through treatment-free intervals, representing a paradigm shift from continuous maintenance to finite treatment duration approaches in multiple myeloma care.