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Novel therapies for multiple myeloma have substantially improved the prognosis, but before patients are able to benefit from treatment, a diagnosis must have been made. The Myeloma UK laboratory working group has developed a three‐part tool box to help primary care physicians to suspect myeloma despite mostly vague symptoms, to do the right tests and to derive the proper conclusions from the results. Commentary on: Drayson et al. Laboratory practice is central to earlier myeloma diagnosis; utilising a primary care diagnostic tool and laboratory guidelines integrated into haematology services. Br J Haematol 2024;204:476‐486. [ABSTRACT FROM AUTHOR]

Current approved immunotherapeutic agents such as CART cells are limited to patients with at least 3 or even 4 prior lines of treatment. However more and more patients become refractory to standard regimens in earlier lines. Mohyuddin et al. examined the inclusion criteria of current immunotherapeutic trials in myeloma and propose a change to put more emphasis on refractoriness to 3 or more agents and to omit a required number of lines of therapy in current and future protocols. Commentary on: Mohyuddin et al. Inclusion criteria of currently enrolling T‐cell engaging trials in multiple myeloma: Should we be focusing on lines of prior therapy? Br J Haematol 2023;202:e1‐e2. [ABSTRACT FROM AUTHOR]

The prospective, randomized phase III trial GMMG- HD2 aimed at demonstrating non-inferiority of single (Arm A) versus tandem (Arm B) high-dose melphalan followed by autologous transplantation ( HDM/ ASCT) with regard to 2-year event-free survival ( EFS) in newly-diagnosed multiple myeloma ( MM) and included 358 evaluable patients [Intention-to-treat population, ( ITT), single/tandem HDM/ ASCT: n = 177/181]. After a median follow-up of more than 11 years, non-inferiority of single versus tandem HDM/ ASCT was demonstrated using the planned non-inferiority threshold of 15% of the 2-year EFS rate. Neither EFS ( P = 0·53) nor overall survival ( OS) ( P = 0·33) differences were observed in the ITT population. In the tandem arm, 26% ( n = 47/181) of patients refused a second HDM/ ASCT due to non-medical reasons. A per-protocol ( PP) analysis, including patients who received the intervention (single/tandem HDM/ ASCT: n = 156/93) and patients who did not receive a second HDM/ ASCT due to medical reasons (12%, n = 22/181), did not yield differences in EFS ( P = 0·61) or OS ( P = 0·16). In the ITT and PP set of the tandem arm, the rates of complete responses increased from first to second HDM/ ASCT (both P = 0·04). Ten-year OS for the entire ITT was 34% (95% confidence interval: 29-40%). OS after first relapse was significantly shortened in the tandem arm ( P = 0·04). In this study single HDM/ ASCT was non-inferior to tandem HDM/ ASCT in MM. [ABSTRACT FROM AUTHOR]