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IMS 2026 | Emerging treatment strategies for extramedullary myeloma
Paul Richardson, MD, Dana-Farber Cancer Institute, Boston, MA, discusses treatment approaches for extramedullary disease (EMD) in relapsed/refractory (R/R) multiple myeloma. He highlights the challenges associated with EMD, particularly following immunotherapy, and explores emerging treatment strategies including melflufen and selinexor, while emphasizing the need for further research into combination approaches and therapies targeting the biology of EMD. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
Well, this extramedullary disease session that it’s my privilege to present with my colleague, Dr Ajay Nooka from Emory. Ajay and I have really worked hard on this presentation and we’ve worked with input from colleagues as well with special interest in EMD. So we’re hoping the educational session will be informative to our audience. We’re really breaking it up according to pathobiology and then treatment options...
Well, this extramedullary disease session that it’s my privilege to present with my colleague, Dr Ajay Nooka from Emory. Ajay and I have really worked hard on this presentation and we’ve worked with input from colleagues as well with special interest in EMD. So we’re hoping the educational session will be informative to our audience. We’re really breaking it up according to pathobiology and then treatment options. And I think what we have to realize is that EMD is really a barrier to treatment success. In fact, it’s a very challenging entity, particularly the relapsed/refractory space. Obviously, when immunotherapy fails a patient, patterns of relapse are dominated and enriched for EMD. This, therefore, constitutes a unique challenge. We mentioned the cell mods earlier. Melflufen uniquely appears to be exquisitely active in extramedullary disease, which we think is very important. Second of all, we see that other treatment strategies, including oral agents like selinexor, may be important. Funny enough, we’re talking about peptide drug conjugates. Melflufen is particularly suited to the EMD setting for a variety of reasons, not least of which the aminopeptidases, which are critical to the activation of the alkylator moiety in the peptide drug conjugate, are enriched in extramedullary disease. There are other treatment strategies that target it. So I think we’re going to talk a lot about the therapeutic opportunities, but also be very realistic about the challenges. So I think EMD, an area for further research, new treatments, further combination strategies. But I have to say a lot of work to be done, to be fair.
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