What are the EHA-ESMO guidelines for second-line therapy to treat multiple myeloma (MM)?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

EHA-ESMO guideline recommendations for second-line therapy of MM include the following [132] :

  • Second-line ASCT is an option for patients who received primary therapy that included an ASCT followed by lenalidomide maintenance and whose initial remission lasted for ≥36 months.
  • Patients who received bortezomib-based therapy upfront without lenalidomide or daratumumab should receive lenalidomide/dexamethasone plus carfilzomib, daratumumab, ixazomib, or elotuzumab. Daratumumab/lenalidomide/dexamethasone provides the best PFS for these patients, while only carfilzomib/lenalidomide/dexamethasone and elotuzumab/lenalidomide/dexamethasone have shown an OS benefit over lenalidomide/dexamethasone to date.
  • Patients with MM refractory to upfront lenalidomide could receive pomalidomide/bortezomib/dexamethasone, daratumumab/carfilzomib/dexamethasone, ixazomib/carfilzomib/dexamethasone, or daratumumab/bortezomib/dexamethasone. Of those regimens, only pomalidomide/bortezomib/dexamethasone has been approved yet by the EMA.
  • Venetoclax/bortezomib/dexamethasone is a suitable option for patients with t(11;14) MM that has failed to respond to lenalidomide and is sensitive to proteasome inhibitors, if available.

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