Advances in the pathophysiology and treatment of anaemia in multiple myeloma

Anaemia is a common sign in multiple myeloma due to multifactorial mechanisms. Apart from the well known factors related to the disease, more recently, the use of several new drugs as the immunotherapeutic ones indicates the emerging role of drug-related mechanisms in the pathophysiology of anaemia in multiple myeloma patients.

Anaemia associated with immunomodulatory drugs may result from both direct effect on hematopoietic progenitor cells and indirect one mediated by cytokine modulation within the bone marrow microenvironment. The CD38 expression by erythroid lineage cells, suggests that anti-CD38 antibodies may induce apoptosis or functional inhibition of these progenitors, leading to reductions in erythropoiesis. Recent clinical trials also reported ad high incidence of anaemia in multiple myeloma patients treated either with bispecific antibodies or CAR-T cells.Treatment of anaemia in multiple myeloma patients included the use of red blood cell transfusion and erythropoietin-stimulating agents but recently novel agents were under investigation as the activin receptor fusion proteins.

The use of the new immunotherapeutic drugs in multiple myeloma patients is associated with an increased incidence of anaemia that should be considered by clinicians particularly in the management of those patients in which coexist other anaemia-related factors.