MULTIPLE MYELOMA AND OTHER PLASMA CELL DISEASES

multiplemyelomawos

CONVENTIONAL MANAGEMENT OFLATE-LINE RELAPSE IN MULTIPLE MYELOMA

Selin Küçükyurt Kaya1 Engin Kelkitli2

1Ankara Etlik City Hospital, Department of Hematology, Ankara, Türkiye
2On Dokuz Mayıs University, Faculty of Medicine, Department of Hematology, Samsun, Türkiye

Küçükyurt Kaya S, Kelkitli E. Conventional Management of Late-Line Relapse in Multiple Myeloma. In: Sevindik ÖG, editor. Multiple Myeloma and Other Plasma Cell Dyscrasias. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.65-77.

ABSTRACT

Multiple myeloma (MM) is an incurable plasma cell malignancy despite significant therapeutic advancements. The introduction of proteasome inhibitors (PI), immunomodulatory drugs (IMiDs), and monoclonal antibodies has transformed treatment paradigms, improving overall survival (OS). However, MM patients often face aggressive relapses with each remission shortening due to resistant clones. Late-line relapse presents a complex therapeutic landscape, requiring a tailored approach based on factors such as prior treatment exposure, drug refractoriness patterns, disease aggressiveness, and patient-specific considerations like performance status and comorbidities. Treatment strategies should prioritize balancing efficacy and tolerability, leveraging drug synergies while mitigating toxicities. For instance, switching drug classes or incorporating secondor third-generation agents can enhance outcomes, while previous adverse events may necessitate avoiding some regimens. The treatment goal balances prolonging survival with maintaining quality of life. Conventional treatment approaches for second-line and subsequent relapse include PIs, IMiDs, monoclonal antibodies (daratumumab, isatuximab, elotuzumab), alkylator-based therapies, anthracycline-containing regimens and stem cell transplantation. This chapter will focus on the effects, side effects, efficacy, combinations, and selection of these agents in this patient group.

Keywords: Multipl myeloma; Relapse; Proteasome inhibitors; Immunomodulating agents; Daratumumab; Elotuzumab; Bone marrow transplantation; Bendamustine

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