The progress in multiple myeloma.

Abstract

Multiple myeloma (MM) is a neoplastic disease characterized by the proliferation of clonal plasma cells. This disease arises from an initial asymptomatic stage known as monoclonal gammopathy of unknown significance (MGUS). The clinical phenotype that lies between MGUS and MM is commonly known as smoldering multiple myeloma (SMM). In individuals with MGUS and SMM, the risk of progression to MM persists constantly. In MGUS, the progression rate to MM or a related malignancy is around 1% per year, while in SMM, the progression rate to MM is approximately 10% per year. Recently, myeloma was defined as a clonal proliferation of malignant plasma cells that results in end organ damage or myeloma-defining events. MM is a genetically complex disease that exhibits clinical and biological diversity. Currently, the revised International Staging System (R-ISS) is used for prognostication in newly diagnosed patients. For transplant-eligible patients with newly diagnosed MM, the standard of care treatment (SoC) regimen is induction therapy, followed by ASCT and maintenance therapy. In general, the recommended induction therapy is a triplet or quadruplet-agent therapy consisting of a proteasome inhibitor, an immunomodulatory compound, and/or a CD38 antibody in combination with dexamethasone. Myeloma patients who are ineligible for a transplant are typically treated with a triplet combination, which necessitates specialized knowledge of treatment adverse effects. Although the prognosis for patients with MM has significantly improved over time due to advances in treatment, the disease remains incurable and relapses are common. Because various immunotherapeutic agents, new drugs and combinations have become available, selecting the most effective treatment for patients with relapsed/refractory MM needs both art and science.