Current Treatment Approaches to Newly Diagnosed Multiple Myeloma
Susanne Ghandili1, Katja C Weisel1, Carsten Bokemeyer1
1Department of Hematology, Oncology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Background:
Multiple myeloma is a so far incurable malignant plasma cell disorder. During the past 2 decades, treatment paradigms substantially changed when novel drugs were introduced initially in treatment of relapsed disease and subsequently also in first-line treatment.
Summary:
Up to now, first-line treatment differs between patients initially classified as transplant eligible and those who are considered as nontransplant eligible. Transplant-eligible patients receive a primary proteasome inhibitor (PI)-based induction which is being combined with an immunomodulating agent and a CD38-directed monoclonal antibody followed by high-dose melphalan therapy and autologous stem cell transplantation with subsequent maintenance treatment with lenalidomide. Patients who are considered as nontransplant eligible receive upfront treatment preferentially with a continuous combination treatment either with a CD38-directed monoclonal antibody in combination with the immunomodulating agent lenalidomide or a lenalidomide-PI combination followed by lenalidomide maintenance. Key Messages: Primary goal of the initiated treatment is to induce a rapid and deep remission which ideally leads to an eradication of the residual plasma cell clone in sense of a minimal residual disease negativity. Achievement of long-term remission with limited toxicity despite continuous treatment strategies and maintenance or improvement of life-quality is key. Despite successful treatment options, specific difficult-to-treat subgroups, especially patients with high-risk myeloma remain with inferior prognosis and a clear unmet need for novel therapeutic strategies. Future concepts will evaluate cellular treatments and other innovative immunotherapies in first-line treatment in curative intention.
Insights
Novel therapies have transformed multiple myeloma treatment, offering improved remission and quality of life. However, high-risk patients still need better therapeutic strategies for this incurable plasma cell disorder.
Area of Science:
- Hematology
- Oncology
- Immunotherapy
Background:
- Multiple myeloma is an incurable malignant plasma cell disorder.
- Treatment paradigms have evolved significantly over the past two decades with the introduction of novel drugs.
- These advancements have impacted both relapsed and first-line treatment settings.
Purpose of the Study:
- To summarize current first-line treatment strategies for multiple myeloma.
- To highlight the differences in treatment approaches for transplant-eligible versus nontransplant-eligible patients.
- To identify unmet needs and future directions in multiple myeloma therapy.
Main Methods:
- Comparison of current first-line treatment protocols for transplant-eligible and nontransplant-eligible multiple myeloma patients.
- Review of therapeutic agents including proteasome inhibitors, immunomodulating agents, and CD38-directed monoclonal antibodies.
- Analysis of treatment goals, including achieving minimal residual disease negativity and maintaining quality of life.
Main Results:
- Transplant-eligible patients receive proteasome inhibitor-based induction, immunotherapy, CD38 antibody, followed by high-dose melphalan, stem cell transplantation, and lenalidomide maintenance.
- Nontransplant-eligible patients receive continuous combination therapy with CD38 antibody/lenalidomide or lenalidomide/proteasome inhibitor, followed by lenalidomide maintenance.
- The primary goal is rapid, deep remission and minimal residual disease negativity.
Conclusions:
- Current first-line treatments aim for deep remission and improved quality of life.
- High-risk multiple myeloma patients still face a poor prognosis, indicating a need for novel therapies.
- Future research will explore cellular therapies and innovative immunotherapies for curative intent in first-line treatment.
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