Expert Perspectives on Current Challenges and Emerging Approaches for Multiple Myeloma: Narrative Review of an Inaugural Bridging the Gaps in Leukemia, Lymphoma, and Multiple Myeloma

Ajai Chari; Susan Bal; Sikander Ailawadhi; Amrita Krishnan; Krina K Patel; Jesus G Berdeja; Alfred Garfall; Natalie Callander; Rahul Banerjee; Melissa Alsina; Ajay K Nooka; Binod Dhakal; Cristina Gasparetto; Caitlin Costello

doi:10.1016/j.clml.2025.03.008

Expert Perspectives on Current Challenges and Emerging Approaches for Multiple Myeloma: Narrative Review of an Inaugural Bridging the Gaps in Leukemia, Lymphoma, and Multiple Myeloma

Clin Lymphoma Myeloma Leuk. 2025 Mar 11:S2152-2650(25)00098-9. doi: 10.1016/j.clml.2025.03.008. Online ahead of print.

Authors

Affiliations

¹ Division of Hematology/Oncology, University of California San Francisco, San Francisco, CA. Electronic address: ajai.chari@ucsf.edu.
² Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
³ Division of Hematology-Oncology, Mayo Clinic Florida, Jacksonville FL.
⁴ Judy and Bernard Briskin Myeloma Center, City of Hope Comprehensive Cancer Center, Duarte, CA.
⁵ Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁶ The Greco-Hainsworth Tennessee Oncology Centers for Research, Nashville, TN.
⁷ Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
⁸ Division of Hematology, Oncology and Palliative Care, University of Wisconsin Carbone Cancer Center, Madison, WI.
⁹ Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
¹⁰ Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
¹¹ Department of Hematology and Medical Oncology, Winship Cancer Institute, School of Medicine, Emory University, Atlanta, GA.
¹² Blood and Marrow Transplant (BMT) and Cellular Therapy, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.
¹³ Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC.
¹⁴ Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, CA.

PMID: 40175263
DOI: 10.1016/j.clml.2025.03.008

Abstract

Purpose: The management of multiple myeloma (MM) is becoming increasingly more complex. The approval of novel treatment approaches provides much-needed opportunities but also raises questions and controversies about how to optimally sequence therapies and select treatments for individual patients.

Methods and results: A panel of experts assembled to discuss current controversies in the care of patients with MM across the disease continuum. Workshop topics included: management of smoldering MM; treatment selection for transplant-eligible and transplant-ineligible patients; risk assessment and the possibility of risk-adapted treatment; use of measurable residual disease (MRD) as a clinical trial end point and to guide treatment decisions; management of early relapse; management of triple class-refractory MM; treatment sequencing; and novel therapies.

Conclusion: Many controversies remain regarding the management of patients with MM related to risk assessment, treatment selection and sequencing, and the optimal use of current therapies while balancing efficacy, toxicity, patient considerations, and treatment logistics. Ongoing research efforts are needed to further define the optimal use of current therapies and to develop more efficacious therapies for all patients and for particular subset populations with unmet need.

Keywords: CAR T-cell therapies; Early relapse; Relapse/refractory multiple myeloma; Smoldering multiple myeloma; Transplant; Triple-class refractory multiple myeloma.