Treatment of Myeloma: First Relapse

Authored by Vincent Rajkumar, published on 2026-10-16 09:02:42.0

Not Refractory to Anti-CD38

Watch Dr. Rajkumar's intro video on Treatment of Myeloma: First Relapse (1:20).
- Unable to give cell therapy and bispecifics
  - Standard Triplet**
    
    ** Choice of standard triplet is based on refractoriness to Len, anti-CD38, and other drugs. Key options are DRd, KRd, KPd, Anti CD38-Pd, Anti CD38-Kd, EloPd, Dara-KPd, PI-Cd and choose a triplet with at least two drugs the patient is not refractory to.
- Have access, and able to give cell therapy and bispecifics
  - BCMA CART* or Tec-Dara
    
    *Cilta-cel should be considered in eligible patients, and patients should have a discussion on pros and cons of a one-time CART approach vs prolonged therapy.
Refractory to Anti-CD38

Watch Dr. Rajkumar's video walk through.
- Have access, and able to give cell therapy
  - BCMA CART* or BCMA Bispecific
    
    *Cilta-cel should be considered in eligible patients, and patients should have a discussion on pros and cons of a one-time CART approach vs prolonged therapy.
- Unable to give cell therapy and bispecifics
  - Standard Triplet**
    
    ** Choice of standard triplet is based on refractoriness to Len, anti-CD38, and other drugs. Key options are DRd, KRd, KPd, Anti CD38-Pd, Anti CD38-Kd, EloPd, Dara-KPd, PI-Cd and choose a triplet with at least two drugs the patient is not refractory to.
Consider salvage ASCT as alternative in patients eligible for ASCT who have not had transplant before