The first 60 days: Multiple myeloma

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

• Newly diagnosedNCCN Guidelines: Multiple Myeloma

  Dara-VRd ± ASCT → lenalidomide maintenance.

  Whole-body MRI
• Newly diagnosed, transplant-eligibleNCCN category Category 1 (Dara-VRd), ESMO-MCBS A, NCCN 2026 / EHA-ESMO 2021 update

  Dara-VRd (or Isa-VRd) induction × 4-6 → stem-cell collection → high-dose melphalan + autologous transplant → Dara-VRd consolidation → lenalidomide (± daratumumab) maintenance; MRD-guided de-escalation emerging (PERSEUS design). Tandem transplant or extended therapy for high risk.

  PERSEUSDaratumumabBortezomibLenalidomideAutologous stem cell transplant (high-dose therapy)MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)
• Newly diagnosed, transplant-ineligibleNCCN category Category 1, NCCN 2026

  Dara-VRd (CEPHEUS) or Isa-VRd (IMROZ) with bortezomib de-escalation after induction; Dara-Rd (MAIA) for frailer patients; continuous therapy with dose adjustment for frailty.

  CEPHEUSIMROZDaratumumabIsatuximabLenalidomide

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• PathologistNamed in the standard of care for: Relapsed.
• RadiologistNamed in the standard of care for: Newly diagnosed.
• Medical oncologistNamed in the standard of care for: Relapsed, High-risk smouldering myeloma, Newly diagnosed, transplant-eligible, Newly diagnosed, transplant-ineligible and 4 more.
• Clinical oncologist (radiotherapy)Named in the standard of care for: Supportive care.
• Transplant and cell therapy teamNamed in the standard of care for: Relapsed, Newly diagnosed, transplant-eligible, First relapse (1-3 prior lines), Triple-class refractory (≥3-4 prior lines).

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.High-risk smouldering myelomaNCCN category Category 2A (daratumumab or lenalidomide for high-risk SMM), NCCN 2026

   Consider daratumumab monotherapy (AQUILA) or lenalidomide (E3A06), or trial enrolment; shared decision given indolent course in many.

   DaratumumabLenalidomideSmouldering myeloma / MGUS
2. 2.MGUS / low-risk smoulderingNCCN category Observation, NCCN Multiple Myeloma 2026

   Observation with periodic labs; no treatment outside trials.

   Smouldering myeloma / MGUSiStopMM
3. 3.RelapsedNCCN Guidelines: Multiple Myeloma

   CAR-T or bispecific; belantamab combinations; sequencing by prior exposure.

   Ciltacabtagene autoleucelTeclistamabBelantamab mafodotin
4. 4.First relapse (1-3 prior lines)NCCN category Category 1 (cilta-cel ≥1 line; tec-dara ≥1 line), NCCN 2026

   Cilta-cel if lenalidomide-refractory (CARTITUDE-4); teclistamab + daratumumab (MajesTEC-3, 2026); ide-cel after ≥2 lines; belantamab-Vd or -Pd (DREAMM-7/8); CD38-based triplets (Dara-Kd, Isa-Kd, Dara-Pd) by prior exposure; carfilzomib or pomalidomide combinations.

   Ciltacabtagene autoleucelCARTITUDE-4TeclistamabMajesTEC-3Idecabtagene vicleucelKarMMa-3Belantamab mafodotinDREAMM-7DREAMM-8Carfilzomib
5. 5.Triple-class refractory (≥3-4 prior lines)

   BCMA CAR-T if not yet given; bispecifics (teclistamab, elranatamab, linvoseltamab; talquetamab after BCMA exposure); belantamab; selinexor-based; CELMoDs in trials; anito-cel (PDUFA Dec 2026).

   TeclistamabElranatamabLinvoseltamabTalquetamabBelantamab mafodotinMezigdomideAnitocabtagene autoleucelBCMA-directed therapy → GPRC5D-directed therapy
6. 6.Maintenance

   Lenalidomide until progression (CALGB 100104, Myeloma XI); daratumumab added for high-risk or per PERSEUS; MRD-guided discontinuation in trials (DRAMMATIC, MASTER); iberdomide maintenance (EXCALIBER) pending.

   LenalidomideDaratumumabIberdomideMRD-guided treatment-free intervals in myelomaDRAMMATIC
7. 7.Supportive care

   Bisphosphonate or denosumab for bone disease; IVIG, antiviral, PJP prophylaxis and vaccination during T-cell redirection; thromboprophylaxis with IMiDs; renal protection; radiotherapy for painful lesions or cord compression.

   Caution: T-cell redirectors and infectionsIMRT / IGRT (modern external beam)

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• A Clinical Study Comparing SG301 Plus Pomalidomide and Dexamethasone to Placebo Plus Pomalidomide and Dexamethasone in Relapsed or Refractory Multiple Myeloma PatientsPhase 3 · recruiting · NCT06508983A Phase 3 Randomized, Placebo-controlled, Double-blind, Multicenter Study Comparing SG301 in Combination With Pomalidomide and Dexamethasone Versus Placebo in Combination With Pomalidomide and Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma
• A Multicenter, Randomized, Open-label, Parallel-group, Controlled, Superiority Phase III Clinical Study Comparing the Efficacy and Safety of F182112 Versus Standard of Care in Patients With Relapsed or Refractory Multiple MyelomaPhase 3 · recruiting · NCT07579234Phase III Clinical Study of F182112 in Patients With Relapsed or Refractory Multiple Myeloma
• A Phase III Study of Eque-cel in Subjects With Len-refractory RRMM (FUMANBA-03)Phase 3 · recruiting · NCT06464991A Phase III Randomized, Controlled Study of Equecabtagene Autoleucel Injection in Subjects With Lenalidomide-Refractory R/R Multiple Myeloma
• A Phase III, Safety, Tolerability and Efficacy of Combination Treatment of BL-8040 and Granulocyte Colony Stimulating Factor (G-CSF) as Compared to PlPhase 3 · active · NCT03246529A Phase III, Randomized, Placebo-Controlled, Multi-Centre Study Evaluating the Safety, Tolerability and Efficacy of Combination Treatment of BL-8040 and G-CSF as Compared to Placebo and G-CSF for the Mobilization of Hematopoietic Stem Cells for Autologous Transplantation in Subjects With Multiple Myeloma - The GENESIS Study
• A Study Comparing Anitocabtagene Autoleucel to Standard of Care Therapy in Participants With Relapsed/ Refractory Multiple MyelomaPhase 3 · active · NCT06413498A Phase 3, Randomized, Open-Label Study to Compare the Efficacy and Safety of Anitocabtagene Autoleucel Versus Standard of Care Therapy in Participants With Relapsed/Refractory Multiple Myeloma

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• Multiple myeloma: the full pageMultiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment journey: Newly diagnosed, transplant-eligibleFour to six months of a four-drug combination, a stem cell transplant with a hospital stay of a few weeks, two more cycles, then maintenance tablets that continue for years while the disease is monitored down to a few cells in a million.
• Guidelines comparedNCCN, ESMO and NICE side by side for this cancer.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.