With 20 new drug approvals in 20 years, the treatment of relapsed myeloma may appear complex and daunting. Here is a simple way to approach your patient. In first relapse, you essentially 3 main choices: CART (ciltacel), Tec-Dara, or one of the standard triplets (DPd, DKd, etc). In second or later relapse, you have an additional key choice, belantamab. If the patient is not refractory to dara, omit the dara; bispecific alone or non-dara containing triplet (eg KPd). How to choose? We usually decide among these 3-4 key options based on patient choice and feasibility. Some patients may prefer the one shot approach with CART. In some, the disease is too aggressive to consider CART. In some, CART or bispecifics may just not be feasible or available and you have to go with triplet or belantamab. mSMART.org