Case Presentation of Heavily Pretreated Multiple Myeloma

Dr. Luciano Costa from the University of Alabama at Birmingham introduces this Targeted Oncology Case-Based Peer Perspective presentation on bispecific therapy for relapsed/refractory multiple myeloma. As director of the multiple myeloma research and treatment program, Dr. Costa focuses on the current treatment landscape utilizing bispecific antibodies and practical strategies for optimal patient care.

The case involves a 72-year-old male with relapsed/refractory multiple myeloma after four prior therapy lines. First-line treatment consisted of VRd (bortezomib, lenalidomide, dexamethasone) with lenalidomide maintenance, achieving very good partial response with deferred autologous stem cell transplant. Second-line therapy included DPd (daratumumab, pomalidomide, dexamethasone), providing brief disease control. Third-line treatment utilized carfilzomib with dexamethasone, achieving stable disease before progression. Fourth-line therapy involved elotuzumab, pomalidomide, and dexamethasone (EPd) with brief partial response.

The patient presents with ECOG performance status 1 and International Staging System (ISS) stage II disease without extramedullary involvement. Cytogenetic analysis reveals standard-risk multiple myeloma. The disease has become lenalidomide-refractory and immunomodulatory drug-refractory but remains BCMA-naïve. Patient preferences include receiving treatment closer to home in a community infusion center, and he declined CAR-T cell therapy. This represents a typical scenario of heavily pretreated, triple-class refractory multiple myeloma requiring novel therapeutic approaches while accommodating patient preferences for community-based care delivery.