The 2025 Bridging the Gaps Consensus Conference recently provided crucial updates on multiple myeloma management. A panel of 16 experts reviewed the latest clinical data to address existing gaps and therapeutic sequencing. Consequently, they developed 11 consensus recommendations spanning from smoldering disease to relapsed settings. Furthermore, these guidelines emphasize the integration of quadruplet induction and the strategic use of cellular therapies to improve outcomes.

Current Paradigms in Multiple Myeloma Management

The experts reached a strong consensus regarding the use of quadruplet regimens in the frontline setting. Specifically, adding a monoclonal antibody to the standard triplet backbone is now recommended for most patients. Additionally, the panel discussed the role of individualized maintenance therapy based on patient risk factors. However, they noted that the optimal duration of maintenance remains an area for further investigation. Moreover, early referral for CAR-T therapy is critical for patients experiencing early relapse. Therefore, hematologists should coordinate with transplant centers much sooner in the disease course.

Future Directions and Practical Guidance

Notably, the consensus highlights the growing importance of minimal residual disease (MRD) monitoring. Thus, MRD status may eventually guide treatment intensification or de-escalation decisions. Ultimately, these recommendations provide a practical roadmap for clinicians navigating the complex myeloma landscape. By standardizing care across different disease stages, the panel aims to improve long-term patient survival. Finally, ongoing research remains essential to refine these expert-derived pathways and address remaining controversies.

Frequently Asked Questions

What are the benefits of quadruplet induction?

Quadruplet induction regimens, such as those combining a CD38-targeted antibody with a proteasome inhibitor and an immunomodulatory drug, offer higher rates of deep and durable responses compared to standard triplets.

Why is early CAR-T referral recommended in the consensus?

Early referral ensures that patients with relapsed or refractory disease can access specialized cellular therapies before their clinical condition deteriorates, maximizing the potential for significant therapeutic benefit.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a substitute for professional healthcare. Refer to the latest local and national guidelines for clinical practice.

References

Chari A et al. Integrating Recent Evidence and Expert Perspectives Into the Management of Multiple Myeloma: Consensus Recommendations From the 2025 Bridging the Gaps Conference. Am J Hematol. 2026 Apr 21. doi: 10.1002/ajh.70339. PMID: 42014940.

Chari A, Bal S, Ailawadhi S, et al. Expert Perspectives on Current Challenges and Emerging Approaches for Multiple Myeloma: Narrative Review of an Inaugural Bridging the Gaps in Leukemia, Lymphoma, and Multiple Myeloma. Clin Lymphoma Myeloma Leuk. 2025 Sep;25(9):635-645. doi: 10.1016/j.clml.2025.03.008.