The use of novel agents has improved the outcomes of patients with multiple myeloma. However, almost all patients eventually relapsed, became resistant to available treatments, and, thus, required further therapy. To improve the outcomes of relapsed and/or refractory, the best efficacy in each line of treatment should be achieved. Currently, the prognosis of patients who became refractory to triple-class agents including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 antibodies is extremely poor. Moreover, the best treatment regimen for these patients remains unclear. In Japan, the use of B-cell maturation antigen-targeting chimeric antigen receptor T-cell therapy for this patient group was approved. Furthermore, bispecific T-cell engagers and B-cell maturation-targeting antibody-drug conjugate are currently developed. Since it is challenging to identify the optimal sequences, it is important to apply each treatment individually based on clinical trial results. In the educational session, the framework to choose the most optimal treatment based on evidence of relapsed multiple myeloma therapies in each treatment line will be discussed.
Keywords: Multiple myeloma; Optimization; Refractory; Relapse.