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    Relapsed refractory multiple myeloma (RRMM) is characterized by multiple relapses and the development of refractory disease1

    Timeline of relapsed refractory multiple myeloma (RRMM) showing multiple relapses and the development of refractory disease

    Adapted from Kurtin et al 2013.
    MGUS=monoclonal gammopathy of unknown significance.

    • With each relapse, remission periods become shorter, and many patients eventually develop RRMM, which is defined as no response to therapy or progression within 60 days of treatment2-4
    • In the relapsed setting, therapies are generally prescribed until disease progression1
    • The majority of patients may eventually develop disease that is refractory to IMiDs and PIs, and will progress on anti-CD38 therapy5

    Survival rates for heavily pretreated multiple myeloma (MM) remain a high unmet medical need despite the advancements in treatment5

    Graph showing the overall survival of patients with heavily treated multiple myeloma post-daratumumab

    Adapted from Pick et al 2018.

    • In a study, patients with a median 5 prior lines of therapy had a median OS of 3.5 months5

    Continued therapeutic advancements are needed to address the unique clonal nature of the disease at progression6

    Myeloma clones at disease progression

    Myeloma clones at disease progression

    For illustrative purposes only.

    • MM is clonal in nature, and there may be multiple disease clones and/or subclones at initial diagnosis6,7
    • At relapse and later in disease, the clonal landscape may be different than at diagnosis6,7
    • Clonal evolution can lead to drug resistance, disease relapse, and a change in a patient’s risk status and prognosis2,3

    References: 1. Kurtin SE. Relapsed or relapsed/refractory multiple myeloma. J Adv Pract Oncol. 2013;4(4):257-262. 2. Sonneveld P, Broijl A. Treatment of relapsed and refractory multiple myeloma. Haematologica. 2016;101(4):396-406. 3. Jagannath S, Roy A, Kish J, et al. Real-world treatment patterns and associated progression-free survival in relapsed/refractory multiple myeloma among US community oncology practices. Expert Rev Hematol. 2016;9(7):707-717. 4. Rajkumar SV, Harousseau JL, Durie B, et al. Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood. 2011;177(18):4691-4695. 5. Pick M, Vainstein V, Goldschmidt N, et al. Daratumumab resistance is frequent in advanced-stage multiple myeloma patients irrespective of CD38 expression and is related to dismal prognosis. Eur J Haematol. 2018;100(5):494-501. 6. Kumar SK, Rajkumar V, Kyle RA, et al. Multiple myeloma. Nat Rev Dis Primers. 2017;3:17046. 7. National Cancer Institute. Plasma cell neoplasms (including multiple myeloma) treatment (PDQ®)–patient version. https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq. Accessed November 14, 2018.