What are the NCCN preferred regimens for treatment of relapsed multiple myeloma (MM)?

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

For MM that relapses after more than 6 months, the regimen used for primary induction therapy can be repeated. For relapses that occur sooner,  regimens that are NCCN category 1 preferred include the following [2] :

  • Carfilzomib/lenalidomide/dexamethasone
  • Daratumumab/ dexamethasone + carfilzomib or lenalidomide or bortezomib
  • Ixazomib/lenalidomide/dexamethasone
  • Pomalidomide/bortezomib/dexamethasone

Other category 1 regimens are as follows:

  • Bortezomib/liposomal doxorubicin/ dexamethasone
  • Carfilzomib (twice weekly)/dexamethasone
  • Elotuzumab/lenalidomide/dexamethasone
  • Panobinostat/bortezomib/dexamethasone
  • Selinexor/bortezomib/dexamethasone (once weekly)

Newer agents for relapsed or refractory MM include the following:

  • Belantamab mafodotin, a humanized monoclonal antibody directed against the B-cell maturation antigen, is indicated for relapsed or refractory MM in patients who were previously treated with 4 or more prior therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. [6]
  • Isatuximab, a CD38-directed cytolytic antibody, is approved in combination with pomalidomide and dexamethasone, for MM in adults who have received at least 2 prior therapies including lenalidomide and a proteasome inhibitor. It was also approved for the treatment, in combination with carfilzomib and dexamethasone, of relapsed or refractory MM in adults who have received 1-3 prior lines of therapy. [7, 8]
  • Idecabtagene vicleucel, the first chimeric antigen receptor (CAR) T-cell therapy approved for MM, is Indicated for relapsed or refractory MM after ≥4 prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody. [9]

    See Treatment and Medication for more detail.


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