Navigating Treatment Outside of Clinical Trial Exclusion Criteria: Should This Transplant Ineligible Patient Receive Quadruplet Therapy for NDMM?

Navigating Treatment Outside of Clinical Trial Exclusion Criteria: Should This Transplant-Ineligible Patient Receive Quadruplet Therapy for NDMM?

Decision Tree

Achieving a strong response to initial therapy is critical for patients with newly diagnosed multiple myeloma (NDMM), as the first remission typically lasts the longest, and patient attrition with subsequent therapies due to comorbidities, disease progression, and cumulative adverse effects from treatments is common. Given the advanced age and comorbidities common among patients with MM at diagnosis, it is crucial to administer the best available treatments upfront rather than saving them for relapse. Fortunately, the inclusion of anti-CD38 monoclonal antibodies in quadruplet regimens has led to deep and durable responses in patients with NDMM, marking a paradigm shift in this treatment setting.

However, while randomized controlled trials are the gold standard by which drug safety and efficacy are evaluated, the narrow inclusion and exclusion criteria of these studies can leave providers with questions as to whether the benefits and risks of therapy extend to the more diverse, complex patients they encounter in everyday practice. This challenge is relevant for hematologists treating NDMM in transplant ineligible patients. The exclusion of certain patient populations leaves unanswered questions as to whether older patients, as well as patients with comorbidities, may benefit from quadruplet therapy.

To help specialists weigh varied criteria in the context of individual patient characteristics, this unique educational activity allows learners to “build a patient” and receive curated evidence-based insights from Dr. Benjamin Derman on whether this complex patient should be considered for quadruplet therapy and if so, what might be done to improve tolerability. Scores of different possible scenarios are possible to consider real-world variations around age, cytogenetics, performance status, frailty, comorbidities, and patient preferences.

Faculty: Benjamin Derman, MD

Release Date: August 29, 2025

Expiration Date: August 29, 2026