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Updated: May 22, 2025
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
How First-Line Therapy is Changing in non-Transplant Eligible Multiple Myeloma Patients
Francesca Fazio1, Luca Deiana2, Cristian Loi2
1Ematologia - Dipartimento di Medicina Traslazionale e di Precisione - Azienda ospedaliera Universitaria Policlinico Umberto I, Università Sapienza di Roma.
Abstract:
Treatment outcomes for patients with multiple myeloma have improved in recent decades thanks to new insights into the biology of the disease and the introduction of new drugs and therapeutic approaches. More than half of patients with multiple myeloma are not eligible for transplantation, and for years, their treatment has been difficult due to the heterogeneity of this patient group and the lack of treatment options. Recently, attention has focused on the concept of frailty and its quantification in order to adapt the schedule and dosage of treatment to the state of fitness. Modulation of therapy for frailty can reduce side effects and toxicity-related death and define the various successes of therapy. The role of frailty and the development of new tools may provide a way forward to customize the treatment of different patients with multiple myeloma who are not eligible for transplantation. The use of the new association, particularly based on monoclonal antibodies against CD38, showed profound and durable results in terms of progression-free survival and overall survival. Today, these combinations, especially daratumumab-lenalidomide and dexamethasone, represent the "gold standard" of treatment for these patients. The latest quadruplet therapies and cell-directed therapies, including bispecific antibodies and chimeric antigen receptor T-cell (CAR-T) treatment, appear to be very effective and achieve a high rate of negative minimal residual disease. These latter approaches could redefine the population over the age of 65 that is now considered transplant-eligible.
Insights
New multiple myeloma treatments, including CD38 monoclonal antibodies and CAR-T therapy, improve outcomes for non-transplant patients. Frailty assessment helps personalize care, reducing toxicity and enhancing survival for this complex patient group.
Area of Science:
- Hematology
- Oncology
- Geriatrics
Background:
- Multiple myeloma treatment has advanced, but many patients are ineligible for transplantation.
- Treatment for non-transplant eligible patients is challenging due to disease heterogeneity and limited options.
- The concept of frailty is increasingly recognized as crucial for tailoring therapy in older adults.
Purpose of the Study:
- To review recent advances in multiple myeloma treatment for patients ineligible for transplantation.
- To highlight the role of frailty assessment in personalizing treatment strategies.
- To discuss novel therapeutic approaches and their impact on patient outcomes.
Main Methods:
- Review of current literature on multiple myeloma treatment strategies.
- Analysis of the impact of frailty assessment on treatment adaptation.
- Evaluation of novel therapies including monoclonal antibodies, quadruplet regimens, and cell-directed therapies.
Main Results:
- CD38 monoclonal antibody combinations, such as daratumumab-lenalidomide-dexamethasone, show significant progression-free and overall survival benefits.
- Frailty assessment allows for optimized treatment schedules and dosages, reducing side effects and toxicity.
- Emerging therapies like bispecific antibodies and CAR-T treatment demonstrate high efficacy and minimal residual disease negativity.
Conclusions:
- Personalized treatment approaches, incorporating frailty assessment, are vital for non-transplant eligible multiple myeloma patients.
- Novel combinations and cell-directed therapies are transforming outcomes and may expand eligibility for intensive treatments.
- These advancements offer profound and durable results, improving survival and quality of life.
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07:24Repression of Multiple Myeloma Cell Growth In Vivo by Single-wall Carbon Nanotube SWCNT-delivered MALAT1 Antisense Oligos
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