EHA 2025 | Potential treatment strategies for patients with penta-class refractory multiple myeloma

Penta-class refractory patient is something that we are going to explore in the last years and I think that if we consider the opportunities that we have available we have to consider at first the condition of our patient at first. Also their comorbidities and in general the motivation and ambition, the logistics. We have several opportunities coming to us and also available in my daily clinical practice. We can go with the cellular therapies such as bispecific antibodies and the CAR-T in which we can in some way offer to our patients an ambitious treatment with the possibility to in some way have a deeper response MRD negativity and in general a deep control of the disease but but also impacting on tolerability with important supportive care and so on. If we have some patient that is not in the condition to have an approach based on a new cellular therapy, melflufen is something that we can imagine to place in this patient. This is a new concept of chemotherapy, particularly specific and personalized with the peptide drug conjugate that in my opinion is particularly useful also for frail patients, patients that have in some way renal failure or some problem that in some way impact on their conditions and also sometimes on their quality of life. I think that with melflufen we have also an optimal schedule because this is performed only one time per month and also 30 minutes infusion. I think that this is something that can correlate very well with the compliance of our patients. I think that this is also potentially a new backbone for new approach. I imagine that we are going to better explore also the molecular status of our patients because some one are really sensitive to immunotherapy but some seem to be refractory. Maybe we should discover who is today in multiple myelomas because this is not only one multiple myeloma, the heterogeneity needs different profiling and in some way also different response to the drug. I think we have to discover with the chemosensitive patients. This one I think is the one in which we can optimize the use of melflufen that we are approaching in our daily practice and I can confirm that it is really well tolerated and can be something that we can use also in really super heavily treated patients.

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