EHA 2025 Insights: DREAMM-7 and DREAMM-8 Trial Updates on Belantamab-Based Regimens for R/R MM

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The DREAMM-7 and DREAMM-8 trials showcase belantamab mafodotin’s renewed potential in multiple myeloma (MM) treatment, particularly in high-risk cytogenetic subgroups. DREAMM-7 evaluates belantamab mafodotin combined with pomalidomide and dexamethasone, whereas DREAMM-8 compares belantamab mafodotin plus dexamethasone vs dexamethasone alone. Subgroup analyses reveal significant benefits in patients with high-risk genetic features, including del(17p), t(4;14), and t(14;16) mutations, demonstrating superior efficacy compared with standard combinations in these challenging populations.

This antibody-drug conjugate represents a valuable alternative for patients unable to access chimeric antigen receptor (CAR) T-cell therapy or bispecific antibodies due to geographic limitations or institutional capacity constraints. With only 20% of eligible patients currently receiving CAR T therapy, belantamab mafodotin could serve community practices lacking specialized cellular therapy programs. Improved dosing schedules have reduced the previously problematic ocular toxicity, making the treatment more manageable for both patients and health care providers in nonacademic settings.

Sequencing questions remain paramount as belantamab mafodotin approaches potential approval later in 2025. The optimal positioning relative to other BCMA-targeted therapies, including timing considerations and potential combination strategies, requires real-world data collection. Unlike bispecific antibodies, belantamab mafodotin may not require the same level of specialized monitoring infrastructure, potentially democratizing access to BCMA-targeted therapy. However, its impact on subsequent CAR T-cell therapy effectiveness remains unclear, necessitating careful consideration of treatment sequencing strategies in comprehensive myeloma care planning.