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IMS 2026 | Treatment strategies at first relapse in multiple myeloma
Gordon Cook, MB ChB, PhD, FRCP(Glas), FRCPath, Leeds Teaching Hospitals NHS Trust, Leeds, UK, discusses treatment strategies for patients with multiple myeloma at first relapse. He highlights the growing role of immunotherapy, the importance of considering prior treatment exposure and response when selecting subsequent therapy, and the evolving role of antibody combinations and bispecific antibodies in patients previously exposed or refractory to daratumumab. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
It was a great session where we talked about first relapse options. Obviously with the advent of immunotherapy we are keen to get immunotherapy options to patients in earlier lines of treatment and the next stage that’s likely to be accepted as a standard of care will be in first relapse. And first relapse gives you a different insight to patient treatment compared to when you meet them as new patients because you have experienced their tolerance of their first-line treatment, you’ve experienced how their disease responds to treatment, so you get a measure of the biology of the need from the patient point of view and that can help you formulate what is the best strategy for treating first relapse...
It was a great session where we talked about first relapse options. Obviously with the advent of immunotherapy we are keen to get immunotherapy options to patients in earlier lines of treatment and the next stage that’s likely to be accepted as a standard of care will be in first relapse. And first relapse gives you a different insight to patient treatment compared to when you meet them as new patients because you have experienced their tolerance of their first-line treatment, you’ve experienced how their disease responds to treatment, so you get a measure of the biology of the need from the patient point of view and that can help you formulate what is the best strategy for treating first relapse. I think that in first relapse, the options that we have, realistically immunotherapy is going to be the most efficacious. Salvage transplants were a particularly favourable option for certain types of patients in the past. That’s becoming less so, particularly in a country where you have access to the newer agents. That’s not the case across all countries because the new agents are expensive and some healthcare jurisdictions can’t afford them. And therefore a salvage transplant in those settings is still very viable. But we’re fortunate in the UK that we have good access to the newer medications. We don’t have all the immunotherapies in first relapse yet, but we do have the ADC blenrep, for example. Antibody therapy is less likely to be useful because it will become the case that most people will be refractory to daratumumab in the first line. Not everybody, but most people. But everybody will be exposed. So it depends whether antibody combinations and first relapse will work in people who have been exposed and whether it works in people who are refractory. And there is some evidence that suggests that combinations with bispecifics might actually take people who are daratumumab refractory and make a more efficacious line of treatment. So we’re still working through that but there’s more evidence to come really.
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