Multiple myeloma: an overview of drug therapies and supportive care

Multiple myeloma is an incurable plasma cell malignancy. Treatment options have evolved significantly in recent years, improving survival and quality of life. Multiple myeloma is increasingly regarded as a chronic illness, particularly for patients with low-risk disease. For patients fit enough to undergo autologous stem cell transplantation, induction therapy with bortezomib (protease inhibitor), lenalidomide (immunomodulatory drug) and dexamethasone (corticosteroid), followed by transplantation, is the mainstay of treatment. Low-dose lenalidomide is continued after transplantation to help prolong remission. For transplant-ineligible patients, first-line therapy with the monoclonal antibody daratumumab, in combination with lenalidomide and dexamethasone, has significantly improved outcomes. Novel therapeutic options include bispecific T-cell engagers, which redirect a patient's immune cells to kill myeloma cells, and chimeric antigen receptor (CAR) T-cell therapy, where a patient's own T-cells are engineered to target and kill myeloma cells. However, high cost and uncertainty around optimal treatment sequencing remain challenges with the use of these newer treatment options. Patients receiving treatment for myeloma are at risk of treatment-related toxicities and infection, and have significant ongoing supportive care needs. A multidisciplinary approach involving primary care clinicians (e.g. general practitioners, pharmacists) and the treating haematology specialist is invaluable.