Treatment Line Trends In The European Multiple Myeloma Therapeutics Market

Report Overview

The Europe multiple myeloma therapeutics market size was estimated at USD 9.72 billion in 2024 and is expected to grow at a CAGR of 5.76% over the forecast period, to be valued at USD 14.18 billion in 2030. The market growth is driven by the rising incidence of multiple myeloma, increasing use of combination therapies, and wider access to monoclonal antibodies and proteasome inhibitors. Advances in treatment lines, including cell-based therapies and targeted agents, support uptake across relapsed and refractory cases. Favorable reimbursement structures and expanded clinical research across key countries enhance market participation. Continued approvals under conditional or accelerated pathways facilitate early market entry for pipeline products. Strategic partnerships among pharmaceutical companies and research institutions are strengthening the treatment landscape and supporting commercial scale-up across therapy lines.

First-Line Therapy: Consolidation around Quadruplet Regimens and Anti-CD38 Combinations

First-line treatment patterns in Europe are consolidating around quadruplet regimens that combine proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), corticosteroids, and anti-CD38 monoclonal antibodies. Daratumumab-based combinations have rapidly displaced older standards following pivotal trial data demonstrating superior progression-free survival (PFS) and minimal residual disease (MRD) negativity rates.

• Transplant-eligible patients are increasingly initiated on D-VTd (daratumumab, bortezomib, thalidomide, dexamethasone) and D-VRd (daratumumab, bortezomib, lenalidomide, dexamethasone). According to the ALCYONE and CASSIOPEIA trials, these regimens show median PFS exceeding 50 months, nearly doubling historical outcomes with VTD alone.

• In transplant-ineligible patients, D-Rd (daratumumab, lenalidomide, dexamethasone) and D-VMP (daratumumab, bortezomib, melphalan, prednisone) have become dominant. The MAIA study demonstrated a 44% reduction in risk of disease progression or death with D-Rd compared to Rd alone, leading to broad uptake across Western Europe.

Regulatory harmonization by the European Medicines Agency (EMA) and robust reimbursement in Germany, France, and the UK are accelerating daratumumab’s first-line penetration. The use of MRD-guided treatment discontinuation strategies, though not yet standard, is being increasingly integrated in clinical trials and early adopter centers.

Key First-line Multiple Myeloma Treatment Regimens - Dosage, Schedule, and Treatment Duration

Source: European Society for Medical Oncology, National Comprehensive Cancer Network (NCCN) Guidelines, ClinicalTrials.gov 

Second-Line Therapy: Prior Exposure and Refractoriness Drive Heterogeneous Treatment Choices

Second-line treatment selection is stratified based on refractoriness to first-line agents and patient-specific factors such as frailty and cytogenetics. The treatment landscape has fragmented due to multiple cross-resistant patient profiles emerging from earlier daratumumab, lenalidomide, and bortezomib exposure.

• Carfilzomib-based combinations have gained momentum, particularly KRd (carfilzomib, lenalidomide, dexamethasone) and Kd (carfilzomib, dexamethasone). The ASPIRE and ENDEAVOR trials reported median PFS of 26.3 months and 18.7 months, respectively, positioning carfilzomib as a preferred PI in this setting. In Germany and France, carfilzomib usage in the second line has risen by approximately 25% between 2020 and 2023.

• Re-challenge with anti-CD38 agents, typically daratumumab or isatuximab-based triplets, is common in patients with extended response to initial anti-CD38 exposure. The ICARIA-MM trial validated IsaPd (isatuximab, pomalidomide, dexamethasone), yielding a median PFS of 11.5 months, offering an alternative where carfilzomib or lenalidomide resistance is prevalent.

• Selinexor (XPOVIO) and belantamab mafodotin (Blenrep) are increasingly used in patients with early relapse post-anti-CD38 exposure, though ocular toxicity management (for belantamab) and gastrointestinal side effects (for selinexor) limit broader adoption.

Second-line therapy duration is shortening due to rapid clonal evolution and prior class exhaustion. Clinicians in France and Spain are prioritizing earlier enrollment into clinical trials or compassionate access programs when second-line regimens show suboptimal durability.

Third-Line And Beyond: Targeted Immunotherapies Redefine Refractory Disease Management

Treatment in third line and beyond has transitioned from conventional cytotoxic strategies to immune-based and BCMA-targeted therapies, especially for patients classified as triple-class refractory (refractory to PI, IMiD, and anti-CD38).

• BCMA CAR-T therapies, including idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvykti), received EMA approval with demonstrated overall response rates exceeding 75% and median PFS of 12 to 18 months. Early commercial availability in Germany and pilot access programs in France indicate a strong trajectory for CAR-T in heavily pre-treated populations. Manufacturing constraints and cost remain limiting factors, with a median time from leukapheresis to infusion of approximately 5 to 7 weeks.

• Bispecific antibodies, particularly teclistamab (Tecvayli), have begun to shift later-line strategies. Teclistamab demonstrated an overall response rate of 63% with a median PFS of 11.3 months in the MajesTEC-1 study. Off-the-shelf availability and favorable outpatient administration are driving its adoption over CAR-T in select patients.

• Pomalidomide-based regimens, including PomPd and EPd (elotuzumab, pomalidomide, dexamethasone), remain in use but are increasingly supplanted by immunotherapies with higher efficacy in triple-class refractory patients.

Real-world evidence from registries in Germany and Italy indicates that more than 40% of patients in fourth-line or later lines are now receiving BCMA-targeted agents as part of either clinical practice or expanded access programs.

Market Impact And Forward-Looking Trends

• Increased first-line depth of response is prolonging time to second-line therapy, compressing later-line market opportunities.

• High-cost cellular therapies are shifting budget impact analyses, prompting health technology assessment (HTA) agencies to refine value frameworks specific to CAR-T and bispecific antibodies.

• European variation in market access is substantial. Germany has seen the fastest integration of CAR-T and bispecifics due to early reimbursement, while the UK’s NICE processes and Spain’s regional evaluations have resulted in staggered access.

The outcome of MRD-adaptive trials will influence future treatment algorithms, expanded combination strategies integrating bispecifics with IMiDs or PIs, and next-generation BCMA and GPRC5D-directed therapies currently in late-phase trials.