Multiple myeloma treatments at first relapse with bispecifics available

Authored by Manni Mohyuddin, published on 2026-02-13 00:17:55.0

How I think about treatments at first relapse, assuming bispecifics are available at 1st relapse.

  1. Dara sensitive, len refractory
    • Preferred: Tec-Dara (ideally finite duration, consider stop in ~1 year) Alternate: Cilta-cel
  2. Len and dara sensitive
    • Tec-dara (Preferred) Alternate: Dara/len/dex
  3. Dara and len refractory
    • Preferred: Cilta-cel Alternate: Teclistamab (with or without dara) depending on patient preference/risk aversion
  4. Stem cells collected but no prior transplant
    • Continue to defer transplant
  5. Biochemical only relapse after many years of remission in standard risk
    • Continue to observe
tosprivacy