With the results from the IMROZ registrational study and the BENEFIT academic study that have been presented for the first time at ASCO 2024, there is a new standard of care which is a quadruplet-based regimen on the basis of a CD38 monoclonal antibody – in IMROZ and BENEFIT it was isatuximab – plus the bortezomib, lenalidomide, dexamethasone previous old standard of care. This quadruplet has become the new standard of care. Approximately for any transplant ineligible patients but up to 79-80 years old, so non-frail patients, we don’t have data yet for frail patients although data is coming and seems to be saying that the quadruplet will also be applicable to these patients. Before now it’s applicable up to 79 years old approximately, non-frail.

So this is going to be the standard of care and this logically should be replacing the two previous standards of care, bortezomib, lenalidomide, dexamethasone, and daratumumab, lenalidomide, dexamethasone.

Once we’ve said that, what we have discussed in this symposium that I’ve been participating to was that now you’re going to have the quadruplet-based regimen, a number of triplet-based regimens, doublet-based regimens, so you’re going to have a very large palette for options for the patients. Instead of treating all the patients the same way and once you have treated the patients to look after the safety and efficacy and decide if you’re going to change something, most of the time de-escalate but sometimes escalate, instead of doing that, which is what we have done up to now, maybe it’s time to rethink the way of giving the treatment to the patients and really designing at the get-go, at the start, that this patient is fit for the quadruplet. Surely I’m going to give it to the patient and manage it but maybe that patient should receive a triplet and which of the two triplets, bortezomib, lenalidomide, dexamethasone or daratumumab, lenalidomide, dexamethasone, or isatuximab, lenalidomide, dexamethasone, my type. And maybe for some patients only a doublet-based regimen.

So what we have discussed is that we would want that now that we have the quadruplet, experience with the triplet and the doublet, we could tailor better the treatment, not only based on high risk and frailty but even more deeper, further down the road, for example do you still want to transplant your patient or maybe you will want to transplant defer your patient because maintaining the patient on a quadruplet would be something you could give and offer the patients. So really we would like to try to change the way that people are doing their treatment, deciding for the treatment at the very early time when they explain to the patients the way they’re going to be treated and what will be the plan. Really at that timepoint thinking this patient is fit for quadruplet, this patient will receive a triplet etc.