As outcomes are improving in relapsed/refractory multiple myeloma (RRMM), the patient treatment experience is becoming increasingly important in treatment decisions. Toxicities, quality of life, treatment burden, and patient preferences are playing a greater role in ongoing care.

I think that we are at an important inflection point in the history of MM treatment. We have had a wide array of treatment options, especially over the last decade. And, even though the success of these treatments has not been universal, we now have a number of regimens in the RR setting that are achieving overall response rates that are upwards of 70% to 90%, where a majority of patients are in complete remission and are even measurable residual disease (MRD) negative. I think that this gives us a couple of opportunities.

First, when we have several treatment options for RRMM that have roughly comparable efficacies, we can include patient-reported outcomes and toxicities as important decision points when trying to select the best treatment for each individual patient. It is very important to have a good therapeutic relationship with your patients and their families. Physicians often focus on trying to get the best response possible, but, if you talk to patients and their families, they are often actually more concerned with the toxicities of therapy. In fact, they are often willing to compromise on efficacy if it results in fewer side effects and a better quality of life.

This can also change over time. If you are in your first line of therapy, you may have a certain tolerance for risk and you may be willing to accept a certain level of toxicity. However, with additional lines of therapy, side effects can accumulate (eg, patients can experience bone pain, renal failure, neuropathy, and/or fatigue). This is when patients often shift their priorities. So, it is important to have that discussion with patients and to make sure they still feel that the toxicities they are experiencing are worth the perceived benefit.

Also, because patients with RRMM are now achieving high levels of MRD negativity, we can now consider stopping treatment when certain thresholds of MRD negativity are achieved. However, I think that the field still needs to define exactly what MRD negativity is. What is the threshold? Is it more than one measurement? There are a number of recent studies suggesting that when there is sustained MRD negativity combined with a lack of active disease on advanced imaging, it may be appropriate to hold therapy for maintenance. The benefit of this, of course, is that patients are allowed a treatment-free interval.

There are also blood-based MRD assays currently in development that are beginning to have a sensitivity equivalent to that of bone marrow–based flow cytometry or sequencing assays. Blood-based assays not only will allow us to monitor MRD levels without the need for a bone biopsy but also will save patients a lot of money. The co-pays on some of these medications for RRMM can already be a financial burden for patients, let alone the costs associated with traveling back and forth for treatment and the side effects that they experience. So, I think that this is the exciting part about where we are and how we can help reduce the burden on patients with RRMM, both in terms of side effects and financial toxicities.