Dr Kumar on the 2024/2025 NCCN Treatment Updates in Myeloma

"We did a major update for the treatment of relapsed/refractory disease, wherein the major change has been the introduction of immunotherapy over the past year; even though some of the agents were already there, we restructured the approach.”

Shaji Kumar, MD, research chair, Division of Hematology, consultant, Division of Hematology, professor, medicine, Mayo Clinic, discusses 2024 and first quarter of 2025 National Comprehensive Cancer Network (NCCN) updates for multiple myeloma treatment. 

These updates in multiple myeloma have introduced several significant changes that are already influencing clinical practice, Kumar begins. The NCCN guidelines span various aspects of myeloma management, from initial treatment strategies to advancements in relapsed and refractory disease approaches, he explains.

One key update involves the adoption of quadruplet regimens as the new standard of care for newly diagnosed multiple myeloma, Kumar continues. Supported by data from multiple phase 3 trials, these regimens are now recommended for both transplant-eligible and -ineligible patient populations, he says, noting that this shift reflects the growing evidence that quadruplet regimens improve outcomes compared with traditional triplet therapies. Additionally, the guidelines now emphasize more tailored recommendations for maintenance therapy, incorporating 2-drug regimens in certain settings. These updates are informed by phase 3 trial data and specific patient characteristics, providing more personalized guidance, Kumar emphasizes.

The updates also introduced major revisions for relapsed or refractory multiple myeloma, particularly with the integration of immunotherapy, he expands. With new approvals and indications, CAR T-cell therapies are now recommended in earlier lines of treatment, reflecting their efficacy in high-risk, relapsed patients, according to Kumar. The guidelines include a dedicated section highlighting the 3 available bispecific antibodies and 2 approved CAR T-cell therapies for patients with myeloma, providing clearer guidance for their use, Kumar emphasizes.

Finally, diagnostic approaches were updated to address early intervention in smoldering myeloma. Although some recommendations were already included in past guidelines, these revisions offer further clarity and expand on emerging data, he concludes.