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Options available on Relapse after 2nd BMT

A MyMyelomaTeam Member asked a question 💭

After 2nd BMT in late May 2025, I achieve come MRD-NGS negative. I was on Pomlidomide -Dexa maintenance thereafter. But my annual review show MRD positive. Can anyone tell me what are the options available with me ?? Which is the best for me ? Teclistamb & Elranatamab are biospecfics available in India. Car T not yet available.

June 27
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A MyMyelomaTeam Member

Daratumumab & Kyprolis was used during induction before for 2nd BMT for 5 months. Further my organs Kidney / Liver / hearty are fine. CXCR4 shows metabolic activity in soft tissue in one of the Ribs in addition to lesions at other locations.

June 27
MyMyelomaTeam

What treatment options are available after becoming MRD positive following a second bone marrow transplant, when CAR-T is not available?

First, becoming MRD positive after achieving MRD-negative status is understandably concerning, but it doesn't mean all options are exhausted — far from it. This is exactly the moment to Show Full Answer

What treatment options are available after becoming MRD positive following a second bone marrow transplant, when CAR-T is not available?

First, becoming MRD positive after achieving MRD-negative status is understandably concerning, but it doesn't mean all options are exhausted — far from it. This is exactly the moment to have a detailed conversation with your hematologist-oncologist about switching strategies.

Since CAR-T is not yet available in India, the bispecific T-cell engagers you mentioned are very relevant options to explore. Both work by bringing your immune system's T-cells close to myeloma cells to destroy them. Here's a quick overview of the two bispecifics available to you:

- Teclistamab (Tecvayli) — Targets BCMA on myeloma cells. It has shown meaningful response rates in relapsed/refractory myeloma and is FDA-approved. Key side effects include cytokine release syndrome (CRS) and infection risk.
- Elranatamab (Elrexfio) — Also targets BCMA. Similarly approved and has shown strong responses. Side effects are comparable to teclistamab.

Both are given as injections and require step-up dosing to reduce CRS risk. Other options your doctor may consider alongside or instead of bispecifics include:

- Daratumumab-based combinations (if not previously used)
- Carfilzomib (Kyprolis)-based regimens
- Clinical trials, which may offer access to newer therapies

Since you've already been on Pomalidomide-Dexamethasone maintenance, your doctor will factor that into the decision.

No one can say which is "best" without knowing your full history, organ function, and prior treatments — that's truly a conversation for your specialist. But both bispecifics are genuinely promising options worth discussing urgently.

June 27

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