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Updated: Feb 2, 2026
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Navigating the treatment landscape in multiple myeloma: which combinations to use and when?
Hartmut Goldschmidt1, John Ashcroft2, Zsolt Szabo3
1Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, 69120, Heidelberg, Germany. hartmut.goldschmidt@med.uni-heidelberg.de.
Abstract:
Multiple myeloma is one of the most common hematological malignancies, affecting mainly elderly patients. The treatment landscape for the management of this disease has evolved significantly over the past 15 years, and a vast array of therapeutics is now available, including immunomodulatory drugs, proteasome inhibitors, histone deacetylase inhibitors, and monoclonal antibodies. As a result, deciding which drugs to use and when, and whether these should be used in a particular order or combination, can be challenging. Although combination regimens are often associated with deeper responses and better long-term outcomes than monotherapy, and are becoming the standard of care, they may result in significant incremental toxicity; hence, a sequential approach may be more appropriate for some patients. In particular, treatment choices can vary depending on whether the patient has newly diagnosed multiple myeloma, is eligible for transplant, has relapsed and/or refractory multiple myeloma, or is considered to have high-risk disease. In this review, we discuss factors to be taken into account when making treatment decisions in each of these settings. We also briefly discuss possible therapeutic strategies involving agents that may become available in the future.
Insights
Treatment decisions for multiple myeloma are complex due to many available therapies. This review guides optimal drug selection and sequencing for different patient groups, balancing efficacy and toxicity.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Multiple myeloma is a common hematological malignancy primarily affecting elderly individuals.
- The therapeutic landscape has expanded significantly with novel agents like immunomodulatory drugs, proteasome inhibitors, and monoclonal antibodies.
- Selecting optimal treatment strategies, including drug sequencing and combinations, presents a clinical challenge.
Purpose of the Study:
- To review current treatment strategies for multiple myeloma.
- To guide clinicians in selecting appropriate therapies based on patient-specific factors.
- To discuss the evolving treatment landscape and future therapeutic options.
Main Methods:
- Review of current literature on multiple myeloma treatment.
- Analysis of therapeutic options including monotherapy, combination regimens, and sequential approaches.
- Consideration of patient stratification based on disease status (newly diagnosed, relapsed/refractory, transplant-eligible, high-risk).
Main Results:
- Combination regimens often yield deeper responses but may increase toxicity compared to monotherapy.
- Sequential treatment approaches may be beneficial for certain patient populations.
- Treatment decisions must be individualized based on disease status, patient fitness, and risk stratification.
Conclusions:
- Personalized treatment strategies are crucial for optimizing outcomes in multiple myeloma.
- Balancing treatment efficacy with incremental toxicity is essential in clinical decision-making.
- Future therapeutic advancements hold promise for further improving multiple myeloma management.
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