Second relapse multiple myeloma

Authored by Vincent Rajkumar, published on 2026-04-17 07:46:30.0

Treatment algorithm for second relapse multiple myeloma. For BCMA sensitive, approach is similar to first relapse. For second relapse belantamab combinations provide an additional option. Consider salvage ASCT as alternative in patients eligible for ASCT who have not had transplant before; Consider 2°d auto SCT if eligible and had >36 months response duration with maintenance to first ASCT.Active drugs in multiple myeloma reference.mSMART 4.0 risk stratification of active multiple myeloma.

  1. BCMA and Dara sensitive
    • Tec-Dara, or BCMA CAR-T
  2. BCMA sensitive; Dara Refractory
    • BCMA CAR-T or Bispecifics,** or Belantamab combination or Standard triplet*
  3. Refractory to BCMA Bispecific
    • Standard Triplet,* or Belantamab combination
  4. Relapse after Prior BCMA CART
    • Standard triplet,* or Belantamab combination, or Bispecifics**
tosprivacyIde-cel or Standard Regimens in Relapsed and Refractory Multiple MyelomaTeclistamab plus Daratumumab in Relapsed or Refractory Multiple MyelomaTeclistamab in Relapsed or Refractory Multiple MyelomaDaratumumab plus Lenalidomide and Dexamethasone for Untreated MyelomaCilta-cel or Standard Care in Lenalidomide-Refractory Multiple MyelomaBelantamab Mafodotin, Bortezomib, and Dexamethasone for Multiple Myeloma