SOHO Italy 2025 | Managing multiple myeloma in 2025: a US perspective

At this year’s SOHO 2025 Italy meeting, I talked about how we approached multiple myeloma in 2025 from a U.S. perspective. And I can think of really a couple of ways that treatment has really changed in particular in the last year based on recent pivotal data or presentations that have been available in the last year. And so I think the first area is the use of quadruple-based induction therapy for newly diagnosed myeloma patients, whether or not they’re transplant eligible or ineligible in this patient population. This is based on several pivotal studies that have been presented or published. For instance, Dara-VRd is now firmly established as standard care for newly diagnosed transplant-eligible myeloma based on the phase 3 PERSEUS study. And for transplant-ineligible patients, one can either consider Dara-VRd or Isa-VRd based on the CEPHEUS study, IMROZ, or BENEFIT study that evaluated either Dara- or Isa-VRd in the transplant-ineligible patient population. And so I’d really consider at this time, you know, the initial question to ask oneself when seeing a newly diagnosed myeloma patient is not whether or not they’re transplant eligible or ineligible, or whether a patient is quad eligible or ineligible. And if they’re quad eligible, then certainly we would think about a CD38-PI-imid-based combination for induction therapy. In the relapsed-refractory myeloma states, I think something that’s been really transformative has been the earlier availability of BCMA CAR-T therapies for patients with relapsed-refractory myeloma. And now we have two BCMA CAR-T therapies approved for the treatment of relapsed-refractory multiple myeloma. We have cilta-cel that’s now approved for one prior line of therapy as long as the patient’s been PI/IMiD exposed, len-refractory. We have ide-cel for patients with at least two prior lines of therapy who are triple-class exposed. And this has really been transformative for a couple of reasons. One is that now we have this really, really highly effective therapy for patients in early lines of therapy, even if they might be triple-class refractory, one or two lines, patients can actually get to CAR-T therapy with these earlier approvals. And they can get to CAR-T therapy also more effective bridging therapy regimens after apheresis before infusion to hopefully decrease disease burden to improve the safety and efficacy of CAR-T therapies in this context. And in particular, if I have patients in my clinic that I’m seeing that have very short duration response, 18 to 24 months of duration response after initial therapy, this is a patient population I really consider CAR-T therapies, for instance, with cilta-cel to hopefully improve a duration response to responses compared to conventional therapies.

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