EBMT 2026 | Towards precision sequencing in myeloma: selecting therapies in a crowded treatment landscape

Well, this morning, it was a fantastic session. There were five myeloma experts – Joaquín Martínez was co-chairing with me, and we had real experts who are leading investigators and leading authors in major papers, such as Mari-Vi Mateos, Mohamad Mohty, Marc Raab, and Hermann Einsele. So the discussion covered all aspects for newly diagnosed myeloma with an overview of the historical evolving nature of myeloma treatment and, of course, what follows in the relapsed setting. So, with newer therapies, the response rates and depth of response is improving with newly diagnosed transplant-eligible patients. The expected median progression-free survival of 17 years seems to be currently unbeatable. But nevertheless, there is even more effective regimens achieving 100% MRD negativity at induction phase. So it is a real breakthrough that’s happening. 

And so what is the next step? If patients already have received daratumumab at frontline, what is expected for those patients when they relapse? Luckily, those patients are less. So today in the morning, there was a perfect discussion about what is the best treatment during induction and what are the first relapse treatments. And it’s fascinating to hear that more and more patients are receiving CAR-T therapy for first relapse. And in some countries, such as here, the host country, Spain, it is approved. But it’s approved for lenalidomide-refractory patients. So in Spain, they recommend continuing with lenalidomide to be able to demonstrate that the patient is progressing on lenalidomide, to be eligible for a CAR-T therapy, which is the first relapse treatment here. 

But on the other hand, not all countries are lucky in that perspective. And the question comes up, should we transplant patients in relapse and that question was addressed by Dr. Raab. And unfortunately there is not much data to support evidence and in the old induction regimens len-dex versus first relapse transplant was not a very positive finding in favor of transplant, but today we don’t have such data. So there’s a space to question the role of transplant in the relapse setting. So the morning’s session on the overall, all the aspects of myeloma was, I think, was covered very deeply and extensively. 

In the case where newer immunotherapies such as CAR-T and bispecifics are introduced to the patients, the chances that they will fail is also a reality. And in that setting, Dr Einsele, he described the potentials of salvage treatments to follow when one immunotherapy fails, either to give a subsequent CAR-T therapy or bispecific, or how to really make it a precise personalized treatment by looking at and measuring the target levels, such as quantification of BCMA loss or presence of GPRC5D. So change of the target is one approach, one possible way to go, but on the other hand it can be more scientific with more evidence-based approaches.

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