Fast Five Quiz: Multiple Myeloma Management

Joshua Richter, MD; Emmanuel C. Besa, MD


May 16, 2023

A three-drug combination is the standard for relapse, with the choice of regimen varying with each successive relapse. The recent introduction of four-drug regimens (adding a monoclonal antibody to existing three-drug combinations) has raised debate whether patients with newly diagnosed MM should be treated with three- or four-drug combinations, with the main concern being increased toxicity.

Almost all cases of MM develop from MGUS, an asymptomatic premalignant stage. Advances in treatment options such as autologous stem cell transplant (ASCT), targeted agents, and immunotherapy have markedly improved progression-free and overall survival. However, there is currently no treatment that can prevent MGUS from progressing into MM. Blood tests may be performed to check for signs of progression.

Patients who are not initially candidates for a three-drug regimen can receive a two-drug regimen and have the third drug added once their performance status improves. Adjunctive therapies that may be used in MM include plasmapheresis, erythropoietin-stimulating agents, corticosteroids, radiation therapy, and surgical intervention.

Learn more about MM therapies and outcomes.


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