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Cancers & treatments·Sequencing

Relapsed or refractory multiple myeloma: lines of therapy

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4 standard-of-care settings across 2 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersFRα
Third line and beyond11
Other settings2·

Third line and beyond

SubgroupSettingApproachProducts and trialsEvidence
All comersTriple-class exposed, two or more prior linesBCMA CAR-T (cilta-cel or ide-cel, KarMMa-3) where slots and fitness allow; BCMA bispecific (teclistamab, elranatamab, linvoseltamab) otherwise; teclistamab-daratumumab (MajesTEC-3).
Ciltacabtagene autoleucelIdecabtagene vicleucelKarMMa-3CARTITUDE-1TeclistamabElranatamabLinvoseltamabMajesTEC-1MajesTEC-3LINKER-MM1MagnetisMM-3
82
FRαFirst relapse, lenalidomide-refractoryDaratumumab or isatuximab with carfilzomib or pomalidomide and dexamethasone; belantamab mafodotin with bortezomib- or pomalidomide-dexamethasone (DREAMM-7, DREAMM-8); cilta-cel after one to three lines (CARTITUDE-4).
DaratumumabIsatuximabCarfilzomibPomalidomideDexamethasoneBelantamab mafodotinDREAMM-7DREAMM-8Ciltacabtagene autoleucelCARTITUDE-4
91

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersAfter BCMA-directed therapyTalquetamab against GPRC5D (MonumenTAL-1); selinexor combinations; CELMoDs and trispecifics in trials.
TalquetamabMonumenTAL-1SelinexorIberdomideMezigdomideBCMA-directed therapy → GPRC5D-directed therapy
69
All comersToxicity managementStep-up dosing and tocilizumab for cytokine release syndrome, immunoglobulin replacement and antimicrobial prophylaxis on bispecifics, neurological monitoring after cilta-cel, ocular examinations on belantamab.
Step-up dosing (T-cell engagers)Cytokine release syndrome (CRS)ICANS (neurotoxicity)Caution: T-cell redirectors and infections
-

Sequence and caution pairings

SequenceApproved
BCMA-directed therapy → GPRC5D-directed therapy

When a BCMA drug stops working, switching to a drug against a different myeloma protein still produces responses in about two-thirds of patients.

CautionApproved
Caution: T-cell redirectors and infections

Myeloma bispecifics and CAR-T suppress antibody production so profoundly that infections, not the cancer, became a leading cause of death in early trials.

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.