What is multiple myeloma (Plasma Cell Myeloma)?

From the Guidelines

Multiple myeloma treatment should prioritize a combination approach based on disease stage and patient factors, incorporating proteasome inhibitors, immunomodulatory drugs, and corticosteroids, with consideration for high-dose chemotherapy and autologous stem cell transplantation, as well as newer treatments like monoclonal antibodies and CAR T-cell therapy, to improve survival and quality of life. The treatment of multiple myeloma has evolved significantly over the past decade, with the introduction of new agents and a better understanding of the disease's biology 1. Key considerations in managing multiple myeloma include:

• Disease stage and patient factors
• Use of proteasome inhibitors (bortezomib, carfilzomib) and immunomodulatory drugs (lenalidomide, pomalidomide)
• Corticosteroids (dexamethasone) as part of the treatment regimen
• Eligibility for high-dose chemotherapy followed by autologous stem cell transplantation
• Newer treatments such as monoclonal antibodies (daratumumab) and CAR T-cell therapy
• Management of complications like bone disease, anemia, and kidney dysfunction
• Regular monitoring of blood counts, kidney function, and protein levels to track disease progression and treatment response Despite the advancements, multiple myeloma remains incurable for most patients, but modern treatments have extended survival and improved quality of life, with many patients living for years or even decades after diagnosis 1. The Mayo Stratification for Myeloma and Risk-Adapted Therapy guidelines provide a framework for managing relapsed multiple myeloma, emphasizing the importance of considering patient comorbidities and preferences when selecting a treatment approach 1. Overall, a comprehensive and individualized approach to multiple myeloma treatment is crucial for optimizing outcomes and improving patient quality of life.

From the Research

Treatment Options for Multiple Myeloma

• Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: a study found that lenalidomide plus low-dose dexamethasone is associated with better short-term overall survival and with lower toxicity than lenalidomide plus high-dose dexamethasone in patients with newly diagnosed myeloma 2.
• Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant: a randomised, open-label, phase 3 trial found that the addition of bortezomib to lenalidomide and dexamethasone resulted in significantly improved progression-free and overall survival and had an acceptable risk-benefit profile 3.
• Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma: overall survival results from a randomised, open-label, phase 3 trial found that daratumumab plus lenalidomide and dexamethasone increased overall survival and progression-free survival in patients ineligible for stem-cell transplantation with newly diagnosed multiple myeloma 4.

Combination Therapies

• Bortezomib, lenalidomide, and dexamethasone with panobinostat for front-line treatment of patients with multiple myeloma who are eligible for transplantation: a phase 1 trial found that the combination of VRd with panobinostat 10 mg is safe and effective in patients who are newly diagnosed with multiple myeloma and who are transplant eligible 5.
• Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide: a randomised, open-label, phase 3 trial found that pomalidomide, bortezomib, and dexamethasone significantly improved progression-free survival compared with bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma who previously received lenalidomide 6.

Key Findings

• The combination of lenalidomide, bortezomib, and dexamethasone is a effective treatment option for patients with newly diagnosed multiple myeloma 3.
• The addition of daratumumab to lenalidomide and dexamethasone improves overall survival and progression-free survival in patients ineligible for stem-cell transplantation with newly diagnosed multiple myeloma 4.
• Pomalidomide, bortezomib, and dexamethasone is a treatment option for patients with relapsed or refractory multiple myeloma who previously received lenalidomide 6.