Dr. Landgren on the Use of Triplets Versus Quadruplets in Multiple Myeloma

C. Ola Landgren, MD, PhD, chief, Myeloma Service, Memorial Sloan Kettering Cancer Center, discusses the superiority of 3-drug regimens and the next steps in the treatment of patients with multiple myeloma.

In the relapsed/refractory setting, data show that 3-drug regimens are superior to 2-drug regimens. The same is true in the newly diagnosed setting. Until recently, there was controversy surrounding the use of risk-adapted treatment. It was believed that a 2-drug regimen was sufficient for standard-risk patients.

However, recent data show the inferiority of this approach. Triplet regimens should be administered to both standard-risk and high-risk patients regardless of their stratification. Landgren advises against the use of risk-adapted therapy unless there are contraindications or limitations otherwise.

The use of 3- versus 4-drug regimens is the next question, Landgren explains. In light of the new monoclonal antibodies, people are wondering whether they can be added to 3-drug combinations which typically include a proteasome inhibitor, an immunomodulatory drug, and a low-dose steroid.