Service d’hématologie clinique, hôpital Saint-Antoine, Paris, France
Inserm UMRs 938, Paris, France
Université Pierre-et-Marie Curie, Paris, France
Centre Catherine-de-Sienne, Nantes, France
In the past years, multiple myeloma management encompass significant progress with the apparition of the so-called novel agents, proteasome inhibitors (PI) and immunomodulatory drugs (IMiD), and the improvement of supportive care. These progress translated in a significantly better outcome. In fit patients standard first line treatment include an induction based on IMiD and PI, high dose melphalan with autologous hematopoietic stem cell transplantation (ASCT) and consolidation/maintenance. Nevertheless, despite these progresses, for most patients, MM remains incurable and the majority of patients will relapse. Next generation IMiD (pomalidomide) and PI (carfilzomib, ixazomib) and new therapeutic classes: monoclonal antibody (daratumumab, elotuzumab) and pan-deacetylase inhibitors (panobinostat) have shown their efficacy in patients with relapse multiple myeloma. These results led to the approval of some of these new agents for multiple myeloma treatment at relapse. However, increased treatments possibilities at relapse make the choice of the most appropriate treatment more difficult. This review sum up the most important studies and provide evidence to choose the most relevant therapeutic strategy for relapse after ASCT, based on disease, patient and previous treatment related parameters.