From the Guidelines
Multiple myeloma treatment should be initiated with a combination approach based on the stage of disease and patient factors, prioritizing proteasome inhibitors, immunomodulatory drugs, and corticosteroids, as well as newer treatments like monoclonal antibodies and CAR-T cell therapy, to improve survival rates and quality of life.
Treatment Overview
The treatment of multiple myeloma has undergone significant changes in recent years with the introduction of new agents, including pomalidomide, carfilzomib, ixazomib, panobinostat, elotuzumab, and daratumumab 1. These drugs have been incorporated into clinical guidelines and have transformed the approach to treating multiple myeloma patients.
Current Treatment Algorithms
The International Myeloma Working Group (IMWG) diagnostic criteria for multiple myeloma require 10% or more clonal plasma cells in the bone marrow and/or a biopsy-proven plasmacytoma, plus any one or more myeloma-defining events (MDE) 1. The current IMWG staging system incorporates tumor burden and high-risk cytogenetics, and updated IMWG response criteria include definitions for minimal residual disease (MRD) negativity.
Key Considerations
Some key considerations in treating multiple myeloma include:
- The use of proteasome inhibitors (bortezomib, carfilzomib), immunomodulatory drugs (lenalidomide, pomalidomide), and corticosteroids (dexamethasone) as common regimens.
- The potential for high-dose chemotherapy followed by autologous stem cell transplantation in eligible patients.
- The incorporation of newer treatments, such as monoclonal antibodies (daratumumab) and CAR-T cell therapy.
- The importance of supportive care, including medications for bone health (bisphosphonates), pain management, and prevention of infections.
- Regular monitoring of blood counts, kidney function, and protein levels to assess treatment response, as recommended by the latest clinical trials 1.
Recent Advances
Recent advances in the treatment of multiple myeloma have significantly improved survival rates and quality of life for patients, with median overall survival now approaching 6 to 10 years, depending on the age of the patient at diagnosis 1.
From the Research
Treatment Options for Multiple Myeloma
- The combination of bortezomib, lenalidomide, and dexamethasone (VRD) has shown significant efficacy in the treatment of newly diagnosed multiple myeloma 2, 3, 4, 5.
- This regimen has been found to improve progression-free survival and overall survival in patients with newly diagnosed multiple myeloma 2, 4.
- The VRD regimen is typically given for 6-8 cycles, followed by autologous stem cell transplant (ASCT) and maintenance therapy 4.
- The most common adverse events associated with the VRD regimen include neutropenia, infection, and peripheral neuropathy 4, 5.
Efficacy of VRD Regimen
- The VRD regimen has been found to achieve high response rates, including partial response and very good partial response, in patients with newly diagnosed multiple myeloma 2, 4, 5.
- The complete response rate has been found to be around 30-40% after induction therapy with VRD 4, 5.
- The median progression-free survival and overall survival have been found to be around 40-50 months and 70-80 months, respectively, with the VRD regimen 2, 4.
Emerging Therapies for Multiple Myeloma
- New therapies, including immunomodulatory drugs, monoclonal antibodies, and proteasome inhibitors, have significantly improved the treatment outcomes for patients with multiple myeloma 6.
- Emerging molecularly targeted therapies, such as bispecific antibodies and chimeric antigen receptor (CAR)-T cells, are being investigated for the treatment of multiple myeloma 6.
- These new therapies have shown promising results in clinical trials and may offer new treatment options for patients with multiple myeloma in the future 6.