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EHA 2026 | Approaching frontline treatment selection and shared decision making in myeloma in the current era
Fredrik Schjesvold, MD, PhD, Oslo University Hospital, Oslo, Norway, discusses the evolving approach to treatment selection for newly diagnosed multiple myeloma (MM), emphasizing the importance of shared decision-making in this setting. Dr Schjesvold highlights the need to weigh up the benefits and risks of available treatment options, such as transplant versus non-transplant approaches for younger patients and the choice of quadruplet therapy with or without certain agents for elderly patients, considering factors like toxicity and individual patient preferences. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
I think shared decisions are becoming more and more important. I think up to now we have very often had very clear ideas about what is the best treatment more or less for all. I think the differences in pros and cons are increasing. I think one thing is frontline for the younger. Should you do a transplant or not? Transplants give you a longer PFS. It does not give you longer overall survival...
I think shared decisions are becoming more and more important. I think up to now we have very often had very clear ideas about what is the best treatment more or less for all. I think the differences in pros and cons are increasing. I think one thing is frontline for the younger. Should you do a transplant or not? Transplants give you a longer PFS. It does not give you longer overall survival. It gives you several months of sort of not feeling very well. There’s a very small sort of mortality surrounding that, but that’s almost negligible. But the late-line secondary malignancy you get from those doses of chemo is relevant. So for this, it’s what the patient wants. Do they want to go through this? Is this more important with a longer PFS or to not have to do this procedure?
In the elderly, those who are not transplanted, I think the question is more about how many drugs should they get. The best standard is a quadruplet, but for each drug you add, the more toxicity there is. And here there are several options. I think you can give the quadruplet with CD38 and VRD, which is the full treatment. You can skip dexamethasone. We have several trials now showing that that’s probably not so important and the toxicity for the elderly is quite big. You can consider whether to give with or without bortezomib and maybe also use the high risk and aggressiveness and the tumor load situation in the patient to discuss that. The treatment is better, but there’s also neuropathy, so there’s pros and cons there also. And then, of course, more options are coming, but those are the options that are most relevant today in frontline myeloma.
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