This Policy Review presents the International Myeloma Working Group's clinical practice recommendations for the treatment of relapsed and refractory multiple myeloma. Based on the results of phase 2 and phase 3 trials, these recommendations are proposed for the treatment of patients with relapsed and refractory disease who have received one previous line of therapy, and for patients with relapsed and refractory multiple myeloma who have received two or more previous lines of therapy. These recommendations integrate the issue of drug access in both low-income and middle-income countries and in high-income countries to help guide real-world practice and thus improve patient outcomes.

1st Department of Medicine Wilhelminen Cancer Research Institute Wilhelminenspital Vienna Austria; Ottakring Clinic Vienna Austria

Applied Medical Research Clínica Universidad de Navarra University of Navarra and Instituto de Investigación Sanitaria de Navarra Pamplona Spain

Blood Disease Department University Hospital of Lille University of Lille Lille France

Cancer Science Institute of Singapore and Yong Loo Lin School of Medicine National University of Singapore Singapore

Clinical Centre Champalimaud Lisbon Portugal

Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne VIC Australia

Clinical Hospital Dr Manuel Quintela University of the Republic Montevideo Uruguay; British Hospital Montevideo Uruguay

Department of Clinical Therapeutics School of Medicine National and Kapodistrian University of Athens Athens Greece

Department of Haematology Cancer Institute University College London London UK

Department of Haematology Oncology and Stem Cell Transplantation Interdisciplinary Cancer Center University of Freiburg Freiburg Germany

Department of Haematology St Vincent's Hospital University of Melbourne Melbourne VIC Australia

Department of Hematologic Oncology and Blood Disorders Levine Cancer Institute Atrium Health Charlotte NC USA

Department of Hematology Amsterdam UMC Vrije Universiteit Amsterdam Cancer Center Amsterdam Amsterdam Netherlands

Department of Hematology and Bone Marrow Transplantation Poznan University of Medical Sciences Poznan Poland

Department of Hematology and Center for Cancer Research University Hospital of Salamanca Salamanca Spain

Department of Hematology and Oncology Cedars Sinai Medical Center Los Angeles CA USA

Department of Hematology Ankara University Ankara Turkey

Department of Hematology Jagiellonian University Medical College Krakow Poland

Department of Hematology Mayo Clinic Rochester MN USA

Department of Hematology São Germano Clinic São Paulo Brazil

Department of Hematology South Elfsborg Hospital Borås Sweden

Department of Hematology St Olavs Hospital Trondheim Norway

Department of Hematology Stanford University Stanford CA USA

Department of Hematology University Hospital Hôtel Dieu Nantes France

Department of Hematooncology University Hospital Ostrava and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Internal Medicine 2 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine 5 and National Center for Tumor Diseases University Hospital Heidelberg Heidelberg Germany

Department of Internal Medicine Federal University of Rio de Janeiro Rio de Janeiro Brazil

Division of Hematologic Malignancy Department of Medical Oncology Dana Farber Cancer Institute Boston MA USA

Division of Hematology and Oncology Herbert Irving Comprehensive Cancer Center Columbia University New York NY USA

Division of Hematology and Oncology School of Medicine and O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham AL USA

Division of Molecular Pathology Institute of Cancer Research London UK

Division of Oncology and Hematology Department of Internal Medicine University of Nebraska Medical Center Omaha NE USA

Emory University Medical School Emory University Atlanta GA USA

Erasmus Medical Center Rotterdam Netherlands

Faculty of Medicine University of Iceland Reykjavik Iceland

Hackensack University Medical Center New Jersey Medical School Rutgers University Hackensack NJ USA

Hospital Clinic of Barcelona Barcelona Spain

Kantosspital St Gallen St Gallen Switzerland

Karolinska University Hospital Stockholm Sweden

Massachusetts General Hospital Boston MA USA

Mayo Clinic Scottsdale AZ USA

Medical College of Wisconsin Milwaukee WI USA

Memorial Sisli Hastanesi Istanbul Turkey

Moffitt Cancer Center Tampa FL USA

Oncology and Hematology Department Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino Turin Italy

Oslo Myeloma Center Oslo University Hospital and KG Jebsen Center for B Cell Malignancies University of Oslo Oslo Norway

Perlmutter Cancer Center NYU Langone Health New York NY USA

Rigshospitalet Copenhagen University Copenhagen Denmark

Sarah Cannon Research Institute Nashville TN USA

Seràgnoli Institute of Hematology Department of Experimental Diagnostic and Specialty Medicine Bologna University School of Medicine S Orsola Malpighi Hospital Bologna Italy

Service d'Hématologie et Thérapie Cellulaire Hôpital La Milétrie and Centre d'investigation Clinique INSERM 1402 Poitiers University Hospital Poitiers France

Shanghai Chang Zheng Hospital Shanghai China

St James's Institute of Oncology St James's University Hospital Leeds Teaching Hospital's NHS Trust Leeds UK

Translational Genomics Research Institute City of Hope Cancer Center Phoenix AZ USA

University Hospital Marqués de Valdecilla University of Cantabria Santander Spain

University Medical Center Hamburg Eppendorf University of Hamburg Hamburg Germany

University of Calgary Calgary AB Canada

University of California San Francisco Medical Center San Francisco CA USA

Western Cancer Institute Nantes University Hospital Saint Herblain France

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