Another quadruplet therapy for multiple myeloma: the beginning of the end for autologous haematopoietic stem-cell transplantation?

In the past 15 years, treatment frameworks for newly diagnosed multiple myeloma have radically changed. It is important to recall that as recently as 2010, Rajkumar and colleagues1 presented ECOG E4A03, which was a phase 3 trial examining the role of lenalidomide, combined with two different dosing regimens for dexamethasone, that showed a 68% overall response rate (ORR; 10% complete remission rate) after four cycles of therapy, a result considered to be astounding at the time. Fast forward to 2024, the use of triplet induction has nearly been supplanted by four component regimens, typically including an immunomodulatory drug, a proteasome inhibitor, a steroid, and the newest addition, an anti-CD38 antibody.