Despite the individual high efficacy of both BCMA-directed therapies and anti-CD38 antibodies, there is significant clinical concern about combining them. The potential for compounded immunosuppression and severe infection risk is a major barrier shaping clinical trial design and favoring sequential use over concurrent combination.
Combining Bellemaf with VRd induction for newly diagnosed, transplant-ineligible myeloma yields 100% response rates. This potent efficacy is driving its adoption in earlier treatment lines, with the clinical focus shifting to proactively managing its known ocular toxicities through dose adjustments and holds.
The powerful Tec-Dara combination therapy initially showed a paradoxical drop in overall survival due to infections. Mandating IVIG prophylaxis completely negated this early risk, revealing the treatment's true, significant long-term survival advantage. This highlights that aggressive supportive care is critical for maximizing efficacy.
For multiple myeloma patients with the 11;14 translocation who respond poorly to initial induction, BCL-2 inhibition is becoming a crucial targeted strategy. New drug combinations are showing high efficacy, addressing a key unmet need and suggesting this approach will be central to improving outcomes for this specific genetic subset.
The KVA grading scale for Bellemaf's ocular side effects can trigger a grade 2 event based on an ophthalmologist's exam, even if the patient's functional vision (e.g., ability to read or drive) is unaffected. This disconnect between clinical grading and patient experience is crucial for managing treatment holds and counseling.