Second relapse multiple myeloma

Authored by Vincent Rajkumar, published on 2026-03-02 05:46:52.0

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*
      **BCMA Bispecifics can be Teclistamab, Elranatamab, Linvoseltamab, or the Tec-Dara combination
  3. Refractory to BCMA Bispecific
    • Standard Triplet,* or Belantamab combination
      *Choice of standard triplet is based on refractoriness to Len, anti-CD38, and other drugs. Key options are DRd, KRd, KPd, DPd, Dara-KPd, and choose a triplet with at least two drugs the patient is not refractory to.
  4. Relapse after Prior BCMA CART
    • Standard triplet,* or Belantamab combination, or Bispecifics**
      *Choice of standard triplet is based on refractoriness to Len, anti-CD38, and other drugs. Key options are DRd, KRd, KPd, DPd, Dara-KPd, and choose a triplet with at least two drugs the patient is not refractory to. **BCMA Bispecifics can be Teclistamab, Elranatamab, Linvoseltamab, or the Tec-Dara combination
tosprivacyTeclistamab in Relapsed or Refractory Multiple MyelomaDaratumumab plus Lenalidomide and Dexamethasone for Untreated MyelomaCilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma