How do you approach the second-line treatment for a patient with high-risk myeloma relapse early post-autoHCT after Dara-RVD induction?

Depending on the nature of the relapse, I would salvage with DCEP, or carfilzomib-based triplet (KCyD, KPd) with ciltacel as the next step.

Agree with @Dr. First Last. I typically prefer Dara-KPd or KCd as holding therapy and a bridge to cilta-cel. The subgroup data from CARTITUDE-4 showed that patients with early relapse post-ASCT (defined as <18 months) benefited greatly from cilta-cel (Einsele et al., PMID 41519141) - the 12-month PF...

This is clearly a patient with functional high-risk disease. If the patient is eligible to undergo a CAR-T cell therapy, that would be my preference. If you're detecting the relapse early on and the disease burden is still relatively low, I would go ahead with the therapy without any specific bridgi...

I strongly favor cilta-cel in this scenario. Tec-Dara remains an interesting alternative, but even with the MajesTEC-9 results, we don't fully understand the benefit that Dara adds in the setting of refractoriness to it. Second, we don't have absolute PFS data for the high-risk subgroup (only that i...