What are preferred regimens for treatment of multiple myeloma (MM) relapse?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Patients who have a relapse after initial disease control may be treated with any of the agents not already utilized. If the relapse occurs longer than 6 months after the initial therapy, then the initial regimen can be used again.

In addition, National Comprehensive Cancer Network guidelines list the following as preferred regimens for previously treated multiple myeloma [2] :

  • Bortezomib/lenalidomide/dexamethasone
  • Carfilzomib (twice weekly)/dexamethasone (category 1)
  • Carfilzomib (weekly)/dexamethasone
  • Carfilzomib/lenalidomide/dexamethasone (category 1)
  • Daratumumab/bortezomib/dexamethasone (category 1)
  • Daratumumab/lenalidomide/dexamethasone (category 1)
  • Elotuzumab/lenalidomide/dexamethasone (category 1)
  • Ixazomib/lenalidomide/dexamethasone (category 1)

Triplet regimens are the standard, but patients who are considered unable to tolerate three drugs can be started with a 2-drug regimen, with a third drug added once their performance status improves. [2]

In August 2020, the FDA approved carfilzomib/daratumumab/dexamethasone for treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy. Approval was based on data from two open-label studies: in CANDOR, median PFS was not reached for the carfilzomib/daratumumab/dexamethasone arm and was 15.8 months for the carfilzomib/dexamethasone arm; in EQUULEUS, which evaluated carfilzomib/daratumumab/dexamethasone in 85 patients, the overall response rate was 81%, with a duration of response of 27.5 months. [85]  

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