A good response to frontline therapy, ideally with minimal residual disease (MRD)-negativity, is a marker for better long-term outcomes for patients with newly diagnosed multiple myeloma, says Rafael Fonseca, MD. As a result, when considering front-line therapies, Fonseca evaluates the feasibility of transplant and post-transplant therapy.

Goals of induction therapy are to achieve rapid disease control and reverse end-organ damage, adds Jatin J. Shah, MD. Transplant remains an important part of how to treat patients with multiple myeloma, states Shah, noting that trying to achieve a particular MRD level or complete remission does not affect his decision to pursue a transplant.

A lot of focus falls on achieving the best response in the transplant-eligible patient population, says Noopur Raje, MD, but the majority of myeloma patients are elderly and may not qualify for transplant. Administering lenalidomide and dexamethasone continuously can achieve durable remissions in frail patients, states Heather J. Landau, MD, without exposing these individuals to the neurotoxicity that bortezomib therapy can induce.

Combination therapy is crucial in multiple myeloma management, notes Raje, even in relapsed settings. However, most clinicians do not intend to achieve MRD negativity when administering dose-reduced triplet therapy in the frail, elderly population, comments Morie A. Gertz, MD. This is in contrast with the younger, transplant-eligible population, where the depth of response is being pushed as high as possible.