Start activity
Videos Take CE/CME Test
Haematological Malignancies, Multiple Myeloma CE/CME accredited

A visually engaging discussion designed to emulate a ‘live’ panel experience and provide clinicians with practical expert insights to address their clinical challenges. Useful tips below will show how to navigate the activity. Close

Key considerations for treatment selection and sequencing in patients with RRMM: Lessons from real-life clinical practice

  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Interpret factors that must be balanced when choosing therapy for patients with RRMM who have relapsed following 1–3 prior lines of therapy
  • Evaluate alternative treatment strategies for patients with RRMM following >3 prior lines of therapy
  • Identify optimal sequencing strategies for patients with RRMM in both early- and later-line settings

In this case-based activity, three leading experts discuss treatment decision making in patients with RRMM, both in the earlier-line and later-line settings, and how to approach treatment sequencing in an evolving landscape.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of haematologists and oncologists, including haemato-oncologist specialists, involved in the management of RRMM.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Dr Sarah Holstein discloses: Consultancy fees from AbbVie, Bristol Myers Squibb, Janssen Pharmaceuticals, Oncopeptides, Secura Bio and Takeda Pharmaceutical (relationships terminated); Grants/research support from Bristol Myers Squibb and Oncopeptides (relationships terminated).

Dr Nikhil Munshi discloses: Consultancy fees from Amgen, Bristol Myers Squibb, Janssen Pharmaceuticals, Legend Biotech, Novartis, OncoPep, Pfizer and Takeda Pharmaceutical (all relationships terminated); Stock/shareholder (self-managed) OncoPep.

Dr Noopur Raje discloses: Advisory board or panel fees from Caribou Biosciences and Immuneel Therapeutics; Consultancy fees from AbbVie, Amgen, Bristol Myers Squibb, Pfizer, Sanofi and Takeda Pharmaceutical; Grants/research support from Bluebird Bio.

Content reviewer

Alicia Canalejo, MSN, APRN-C has no relevant financial relationships to disclose.

Touch Medical Directors

Holly Gilbert-Jones has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 21 June 2023. Date credits expire: 21 June 2024.

If you have any questions regarding credit please contact

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

Claim Credit

Topics covered in this activity

Haematological Malignancies / Multiple Myeloma
  • 1000+ topical and insightful peer-reviewed journal articles
  • 100+ hours of bite-sized congress highlights
  • 9 major therapy areas packed with the latest scientific advances
  • 150+ specialties offering learn-on-the-go medical education
  • + Concise email updates and newsletters so you never miss out
Register For Free Now
Claim Credit
Key considerations for treatment selection and sequencing in patients with RRMM: Lessons from real-life clinical practice
0.75 CE/CME credit

Question 1/5
Which of the following factors should be considered first, when choosing a treatment strategy for patients with RRMM who have relapsed following 1 to ≤3 lines of therapy?

RRMM, relapsed/refractory multiple myeloma.

Treatment selection for patients with RRMM is challenging and the optimal sequence and choice of drugs is not established. Treatment-related factors, such as type and response to prior therapy, are critical for the selection of a new treatment regimen; it also depends on a range of patient- and tumour-related factors.


RRMM, relapsed/refractory multiple myeloma.


van de Donk, NWCJ. Hematology Am Soc Hematol Educ Program. 2020;2020:248–58.

Question 2/5
You are treating a frail 81-year-old woman with RRMM, hypertension and renal insufficiency. Her disease has high-risk features (bone marrow; 60% with t[4;14]) and she relapsed early on her previous two lines of therapy (VCd followed by Dara-Rd). Which of the following treatment strategies would you adopt now?

C, cyclophosphamide; d, dexamethasone; Dara, daratumumab; Elo, elotuzumab; Isa, isatuximab; K, carfilzomib; P, pomalidomide; R, lenalidomide; RRMM, relapsed/refractory multiple myeloma; V, bortezomib.

A triplet therapy is preferred over dual therapy, since there is evidence that frail patients may have improved outcomes with triplet vs dual therapies; although they are also at higher risk from toxicities vs fit patients.1 There is insufficient evidence to support retreatment with an alternative anti-CD38 mAb such as Isa in anti-CD38 mAb refractory patients.2 There is evidence of increased risk of renal failure with K.3


Isa, isatuximab; K, carfilzomib; mAb, monoclonal antibody.


  1. Mian H, et al. Blood Cancer J. 2023;13:6.
  2. van de Donk, NWCJ. Hematology Am Soc Hematol Educ Program. 2020;2020:248–58.
  3. Mian HS, et al. Ann Hematol. 2021;100:1261–6.
Question 3/5
You are treating a patient with the CAR T-cell therapy, ide-cel, and she asks you what her prognosis is likely to be with the treatment. What do you tell her you will expect to see, using MRD negativity as an indicator for prognosis?

CAR, chimeric antigen receptor; ide-cel, idecabtagene vicleucel; MRD, minimal residual disease.

A systematic review highlighted the strong prognostic value of MRD negativity and confirmed its utility as a surrogate for PFS and OS in MM.1 Subsequently, an analysis of data from the POLLUX (Dara-Rd) and CASTOR (Dara-Vd) trials showed that sustained MRD negativity for ≥6 and ≥12 months  was associated with prolonged PFS.2

From available data for CAR T-cell therapies, a deep initial response, while necessary, is not sufficient for long-term remission.3 Data  from the phase Ib/II CARTITUDE-1 trial further indicates the benefit of sustained MRD negativity. At 27 months’ follow-up, in patients who achieved sustained MRD negativity for ≥6 and ≥12 months, PFS rates were 73.0% and 78.8%; OS rates were 93.5% and 90.8%. Respective values in the overall population were 54.9% and 70.4%.4


CAR, chimeric antigen receptor; d, dexamethasone; Dara, daratumumab; MM, multiple myeloma; MRD, minimal residual disease; OS, overall survival; PFS, progression-free survival; R, lenalidomide; V, bortezomib.


  1. Munshi N, et al. Blood Adv. 2020;4:5988–99.
  2. Avet-Loiseau H, et al. J Clin Oncol. 2021;39:1139–49.
  3. Cappell KM, Kochenderfer JN. Nat Rev Clin Oncol. 2023;20:359–71.
  4. Martin T, et al. J Clin Oncol. 2023;41:1265–74.
Question 4/5
What is one reason why sequencing CAR T cells in the earlier line setting may be optimal?

CAR, chimeric antigen receptor.

Early data for CAR T cells manufactured after response to induction therapy suggested they may be more clinically effective than those obtained from heavily treated RRMM patients, leading potentially to more durable responses to therapy.1

Subsequent data from the KarMMa-3 trial demonstrated how treatment with idecabtagene vicleucel significantly prolonged median PFS vs standard regimens in patients with triple-class–exposed RRMM (13.3 vs 4.4 months, p<0.001).2


CAR, chimeric antigen receptor; PFS, progression-free survival; RRMM, relapsed/refractory multiple myeloma.


  1. Garfall AL, et al. Blood Adv. 2019;3:2812–5.
  2. Rodriguez‑Otero P, et al. N Engl J Med. 2023;388:1002–14.
Question 5/5
In patients treated in the later line, which of the following treatment sequences would you preferentially choose to optimize outcomes, based on available data?

ADC, antibody–drug conjugate; BsAb, bispecific antibody; CAR, chimeric antigen receptor.

Evidence indicates that patients can be successfully treated with a BsAb following CAR T-cell therapy,1 and that earlier referral for CAR T-cell therapy increases the likelihood of successful infusion.2

The ADC belantamab mafodotin-blmf is not currently approved for use, although NCCN guidelines state that it can be useful in certain circumstances, if available through a compassionate use programme.3

Alkylating drugs like bendamustine reduce the number and function of T cells, potentially reducing the efficacy of subsequent BsAb or CAR T-cell therapy.


BsAb, bispecific antibody; CAR, chimeric antigen receptor; NCCN, National Comprehensive Cancer Network.


  1. Touzeau C, et al. HemaSphere. 2022;6:85–6.
  2. Cohen AD, et al. Blood. 2023;141:219–30.
  3. NCCN. Multiple myeloma. Version 3.2023. Available at: (accessed 31 May 2023).
  4. van de Donk, NWCJ. Hematology Am Soc Hematol Educ Program. 2020;2020:248–58.
Back to Activity
Copied to clipboard!
accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72