Overview of Multiple Myeloma Treatment Options
The treatment landscape for multiple myeloma has significantly evolved, incorporating a diverse range of therapeutic agents and combinations.
This progression has been driven by novel drug classes and optimized treatment regimens.
Common Therapeutic Classes
Monoclonal Antibodies Examples: Daratumumab, Elotuzumab
Proteasome Inhibitors (PIs)** Examples: Bortezomib, Carfilzomib, Ixazomib
Drugs (IMiDs)** Examples: Lenalidomide, Thalidomide, Pomalidomide
Histone Deacetylase Inhibitors** – Example: Panobinostat
Emerging Treatments** Cereblon-modulating agents Chimeric Antigen Receptor (CAR) T Cells T cell-engaging bispecific antibodies Antibody-drug conjugates
Treatment Strategies for Newly Diagnosed Patients
Eligible for Autologous Stem Cell Transplantation (ASCT)
Recommended Induction Therapy: Triplet regimen of Bortezomib, Lenalidomide, and Dexamethasone (VRd) Follow-up with ASCT and maintenance therapy using Lenalidomide.
Ineligible for ASCT** Preferred Regimen: Combination of Daratumumab, Lenalidomide, and Dexamethasone (DRd).
Approaches for Relapsed or Refractory Cases – The selection of therapy depends on: – Prior treatments – Duration and quality of previous response
Standard Options: Monoclonal antibody-based regimens combined with an IMiD and/or a PI are recommended.
– Triplet regimens are preferred if tolerated, as they generally provide superior efficacy over doublet regimens.
Examples of Triplet Regimens: Carfilzomib, Lenalidomide, and Dexamethasone (KRd) Daratumumab, Bortezomib, and additional agents depending on prior therapy
Triplet combinations enhance both progression-free survival and overall response rates compared to doublet regimens.
The choice of specific agents and therapeutic combinations is tailored to the patient’s previous treatments, comorbidities, and overall health status.
This systematic approach to managing multiple myeloma emphasizes personalized care to optimize outcomes for each patient.