[Evolving strategies for relapsed multiple myeloma: Toward personalized treatment in 2026].

Abstract

Multiple myeloma (MM) is a malignant plasma cell disorder whose prognosis has significantly improved with the introduction of proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and more recently BCMA-targeted immunotherapies. In 2026, MM is considered a chronic disease requiring individualized sequential treatment strategies. Frontline management is guided by patient fitness, enabling treatment intensity adaptation. At relapse, therapeutic decisions depend on prior response duration, refractoriness, previous drug exposure, and comorbidities. In early relapse, anti-CD38-based combinations, as well as carfilzomib- or pomalidomide-based regimens, remain standards of care. In later lines, BCMA-targeted immunotherapies, including bispecific antibodies and CAR-T cell therapies, have reshaped outcomes. However, these approaches raise challenges related to infectious toxicity and treatment logistics. Optimizing treatment sequencing is therefore critical, integrating disease biology, patient characteristics, and prior therapies.