Our preferred regimens in refractory populations and special scenarios
| Early relapse, refractory to IMID |
| dara/btz/dex or dara/cfz/dex (for younger patients) |
| cfz/len/dex or cfz/pom/dex in fit* |
| ixa/len/dex or ixa/dex in frail or indolent relapse |
| Early relapse, refractory to PI |
| dara/len/dex |
| cfz/len/dex in fit |
| len/dex in frail |
| Dual refractory and later |
| dara/pom/dex |
| elo/pom/dex |
| cfz/pom/dex |
| Bendamustine/btz/dex or bendamustine/len/dex |
| Plasma cell leukemia (at relapse) |
| DCEP or VDT-PACE, then SCT (autologous or allogeneic), if eligible |
| dara/novel PI/novel IMID/dex† |
| Extramedullary myeloma |
| dara/novel PI/novel IMID/dex† |
| SCT (autologous or allogeneic), if eligible |
| Consider radiotherapy |
| Central nervous system myeloma82 |
| We favor combining systemic and intrathecal therapy |
| Systemic therapy should contain IMID |
| Intrathecal therapy can be with methotrexate or cytarabine |
| Consider radiotherapy |
| Early relapse, refractory to IMID |
| dara/btz/dex or dara/cfz/dex (for younger patients) |
| cfz/len/dex or cfz/pom/dex in fit* |
| ixa/len/dex or ixa/dex in frail or indolent relapse |
| Early relapse, refractory to PI |
| dara/len/dex |
| cfz/len/dex in fit |
| len/dex in frail |
| Dual refractory and later |
| dara/pom/dex |
| elo/pom/dex |
| cfz/pom/dex |
| Bendamustine/btz/dex or bendamustine/len/dex |
| Plasma cell leukemia (at relapse) |
| DCEP or VDT-PACE, then SCT (autologous or allogeneic), if eligible |
| dara/novel PI/novel IMID/dex† |
| Extramedullary myeloma |
| dara/novel PI/novel IMID/dex† |
| SCT (autologous or allogeneic), if eligible |
| Consider radiotherapy |
| Central nervous system myeloma82 |
| We favor combining systemic and intrathecal therapy |
| Systemic therapy should contain IMID |
| Intrathecal therapy can be with methotrexate or cytarabine |
| Consider radiotherapy |