International Myeloma Working Group Recommendations for the Treatment of Patients with RRMM

The International Myeloma Working Group developed evidence-based clinical practice recommendations for the treatment of RRMM, with the goal to help guide real-world clinical practice and improve patient outcomes.

The International Myeloma Working Group developed evidence-based clinical practice recommendations for the treatment of patients with relapsed/refractory multiple myeloma (RRMM), which was published in the March 2021 issue of Lancet Oncology and summarized here.

Clinical considerations for patients with RRMM who have received 1 previous line of therapy, including whether the patient has lenalidomide-refractory disease and whether disease progression occurs with daratumumab-based regimens. Recommendations are below:

• For patients not refractory to lenalidomide, preferred options (grade 1A recommendation) are daratumumab plus lenalidomide/dexamethasone or carfilzomib plus lenalidomide/dexamethasone. Alternative options (grade 1B recommendation) are daratumumab plus bortezomib/dexamethasone (DVd), carfilzomib/dexamethasone (Kd), daratumumab plus carfilzomib/dexamethasone (DKd), isatuximab plus carfilzomib/dexamethasone (Isa-Kd), ixazomib plus lenalidomide/dexamethasone, elotuzumab plus lenalidomide/dexamethasone, pomalidomide plus bortezomib/dexamethasone (PVd), or selinexor plus bortezomib/dexamethasone.
• For patients with lenalidomide-refractory disease, switching from an immunomodulatory drug to a proteasome inhibitor is recommended. Preferred options (grade 1A recommendation) are PVd, DKd, or Isa-Kd. Alternative options (grade 1B recommendation) are DVd or Kd. Other options (grade 1C recommendation) are carfilzomib plus pomalidomide/dexamethasone (KPd), daratumumab plus pomalidomide/dexamethasone (DPd), or ixazomib plus pomalidomide/dexamethasone (Isa-Pd).

Recommendations for patients who are in second or higher relapse include:

• Preferred options are any first relapse options that have not been tried, including Isa-Pd, DKd, DPd, Isa-Kd, elotuzumab plus pomalidomide/dexamethasone, or KPd. When daratumumab, carfilzomib, or elotuzumab are not available, pomalidomide plus cyclophosphamide/dexamethasone or pomalidomide/dexamethasone may be considered.
• Alternative approved options include selinexor, addition of panobinostat to proteasome inhibitors, bortezomib/dexamethasone/thalidomide plus cisplatin/doxorubicin/cyclophosphamide/etoposide, belantamab mafodotin (4 lines).
• Other options are investigational agents including melphalan flufenamide, B-cell maturation antigen–targeting agents, including chimeric antigen receptor T-cells or bispecific antibodies, and venetoclax in t(11;14) or BCL2-high expression.

These International Myeloma Working Group recommendations are expected to help guide real-world clinical practice with the goal of improving outcomes for patients with RRMM.

Source: Moreau P, Kumar SK, Miguel JS, et al. Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group. Lancet Oncol. 2021;22:e105-e118.