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Treatment considerations
- Clinical trials have shown quadruplet drug therapies improve response rates, depth of response, and rates of progression-free survival (PFS) compared to triplet regimens for NDMM patients1-3
- The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma recommend quadruplet therapies (anti-CD38 mAb with PI and immunomodulatory drugs) as preferred regimen options (NCCN Category 1) for TE and TIE/TD (for patients <80 years old who are not frail) NDMM patients4*
- Combining multiple drug agents and/or immunotherapies with different but synergistic MOAs are generally effective in MM and may prevent drug resistance and treatment failure5
- Addition of immunotherapies to standard of care regimens generally improve efficacy5
- CAR-T cell therapies provide patients with prolonged treatment-free interval6
As advances in treatment provide disease control and prolong survival, supportive care has become increasingly important7
Bone resorption and pain8,9
- Pain management
- Kyphoplasty
- Assess risk of falls
- Physical therapy
- Denosumab and zoledronic acid decrease skeletal related events
Infection10,11
- Consider prophylaxis with:
- Acyclovir
- Antibiotics
- PJP prophylaxis
- IVIg supplementation
- Vaccination
Hematologic disorders
- G-CSF for neutropenia8
- VTE prophylaxis4
- Blood product transfusions12
- Erythropoiesis-stimulating agents12
Other toxicities
- CRS prophylaxis10,13,14
- Dietary modifications10,15,16
- Skin and nail care10,15-17
- Psychosocial support18
*See NCCN.org for definitions of NCCN categories of preference and NCCN categories of evidence and consensus.
CAR‑T, chimeric antigen receptor T cell; CRS, cytokine release syndrome; G‑CSF, granulocyte‑colony stimulating factor; IVIg, Intravenous immunoglobulin; mAb, monoclonal antibody; MM, multiple myeloma; MOA, mechanism of action; PI, proteasome inhibitor; PJP, pneumocystis jiroveci pneumonia; TD, transplant deferred; TE, transplant eligible; TIE, transplant ineligible; VTE, venous thromboembolism.
1. Voorhees PM, et al. Blood. 2020;136:936-945. 2. Sonneveld P, et al. N Engl J Med. 2024;390:301-313. 3. Moreau P, et al. Lancet Oncol. 2024; 25: 1003–14. 4. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma v.5.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed March 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 5. Offidani M, et al. Expert Opin Pharmacother. 2018;19(2):137-149. 6. Cappell KM, Kochenderfer JN. Nat Rev Clin Oncol. 2023;20(6):359-371. 7. Snowden JA, et al. Br J Haematol. 2011;154(1):76-103. 8. Palumbo A, et al. N Engl J Med. 2011;364(11):1046-1060. 9. Terpos E, et al. Lancet Oncol. 2021;22(3):e119-e130. 10. Rodriguez-Otero P, et al. Lancet Oncol. 2024;25(5):e205-e216. 11. Raje NS, et al. Lancet Haematol. 2022;9(2):e143-e161. 12. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hematopoietic Growth Factors v.3.2026. © National Comprehensive Cancer Network, Inc. 2025. All rights reserved. Accessed March 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. 13. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Management of CAR T-Cell and Lymphocyte Engager-Related Toxicities V.2.2026. © National Comprehensive Cancer Network, Inc. 2025. All rights reserved. Accessed March 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 14. Topp MS, et al. Lancet Oncol. 2015;16(1):57-66. 15. McCullough KB, et al. Curr Hematol Malig Rep. 2018;13(2):114-124. 16. Chari A, et al. Clin Lymphoma Myeloma Leuk. 2024;24(10):665-693.e14. 17. National Cancer Institute. Skin and nail changes during cancer treatment. Accessed April 30, 2025. https://www.cancer.gov/about-cancer/treatment/side-effects/skin-nail-changes. 18. Molassiotis A, et al. Support Care Cancer. 2011;19(1):101-11.
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