Long non-coding RNAs and therapeutic resistance in multiple myeloma: from molecular insights to clinical applications

Multiple myeloma (MM) is a complex hematologic malignancy characterized by the abnormal proliferation of plasma cells in the bone marrow. Despite advances in therapy, resistance remains a significant obstacle to curing the disease. Long non-coding RNAs (lncRNAs), a broad family of regulatory RNA molecules, have recently been recognized as important players in MM biology, influencing disease progression and treatment response. This review explores current insights into the diverse roles of lncRNAs in MM, focusing on their involvement in key molecular processes, including miRNA sponging, epigenetic regulation, apoptosis, and interactions with signaling pathways such as PI3K/Akt and STAT3. Additionally, the review evaluates emerging treatment strategies targeting lncRNAs, including RNA-based therapeutics, CRISPR/Cas9 technology, and exosome-mediated delivery systems, assessing their potential to overcome drug resistance and improve clinical outcomes. By integrating molecular research with clinical implications, this review emphasizes the promise of lncRNAs as biomarkers and therapeutic targets in MM and offers a framework for future research and development.