Dr. Usmani on Treatment Considerations for Second Relapse Myeloma and Beyond

Saad Z. Usmani, MD, FACP, chief of Plasma Cell Disorders and director of Clinical Research in Hematologic Malignancies at Levine Cancer Institute, Atrium Health, discusses treatment considerations for patients with multiple myeloma who are in their second relapse or beyond.

For patients who have relapsed 2 or more times, it is important to combine 2 therapies or mechanisms of action that the patient has not previously been exposed to, Usmani says. However, it is also possible to utilize at least 1 new mechanism of action in combination with another agent that the patient may have already been exposed to if it was not used during the previous relapse, he notes.

Currently, experts in the field are working to determine the best combination for this patient population. It is important to enroll patients on clinical trials with novel therapies, although there are other established options for patients with advanced multiple myeloma, Usmani explains. For example, belantamab mafodotin-blmf (Blenrep) was approved by the FDA in August 2020 for patients who are triple-class refractory. Additionally, selinexor (Xpovio) and dexamethasone are options for this patient population, Usmani says.

Additionally, melphalan flufenamide (Pepaxto), which was also approved by the FDA in February 2021 for select patients with relapsed and triple refractory multiple myeloma, is also an option, Usmani concludes.