What’s on the horizon for relapsed/refractory MM in 2026?

The Multiple Myeloma Hub spoke with Sagar Lonial, Winship Cancer Institute of Emory University, Atlanta, US. We asked, What’s on the horizon for the treatment of relapsed/refractory multiple myeloma (MM) in 2026?

In this interview, Lonial provides an overview of recent and emerging developments in relapsed/refractory MM, highlighting advances in immune-based therapies and their potential to improve outcomes in the early relapsed setting. He also discusses how these approaches may influence treatment decision-making, the movement of novel therapies into earlier lines of treatment, and the broader implications for future disease management.

Key takeaways

• There is growing interest in the use of immune-based therapies earlier in the treatment pathway, particularly in early relapsed MM.¹
• Emerging data in early relapsed MM show that immune-based therapies, including chimeric antigen receptor (CAR) T-cell therapies and bispecific antibodies, have demonstrated improved outcomes compared with established treatment approaches.^1–3 
• In the early relapsed setting, treatment decisions between CAR T-cell therapies and bispecific antibodies are increasingly informed by considerations including treatment duration, toxicity, and patient preference.
  • CAR T-cell therapies offer a one-time treatment approach with no ongoing therapy after administration, whereas bispecific antibodies are given as continuous treatment, which may influence patient choice.⁴
  • The movement of these therapies into earlier lines of treatment raises questions regarding optimal sequencing, maintenance strategies, and the role of autologous stem cell transplantation.
• New data are anticipated for additional agents, including next-generation immunomodulatory therapies such as cereblon E3 ligase modulatory drugs (CELMoDs) – both as single agents and in combination with other treatments for relapsed/refractory MM.
• There is increasing discussion around treatment duration, particularly whether continuous therapy will remain the standard approach given the deep and sustained responses achieved with immune-based therapies.
• Overall, the rapid development of immune-based therapies is contributing to a shift in the multiple myeloma treatment landscape and may impact how the disease is managed across different stages.