Multiple myeloma – current status and future directions

Abstract

Introduction: Multiple myeloma (MM) is a largely incurable plasma cell-derived cancer which requires treatment once clinical symptoms arise. Several ‘novel drugs' (proteasome inhibitors, immunomodulators) have been introduced during the last decade resulting in an improved prognosis. To maximize response quality and duration, multi-drug combinations, alternating sequences and low-dose ‘continuous' treatments are currently used. Among patients with MM relapse, those with extramedullary disease (EMD) are particularly challenging when it comes to treatment. Hopefully, genomic studies will in the future help to understand the clonal back and forth of MM tumors. This may ultimately result in the development of more ‘targeted' drugs. As of yet, only 4% of MM patients harbouring the BRAF V600E mutation feature a ‘druggable' genetic target. Areas covered: We review current treatment options, their limitations in particular settings and potential future approaches. We performed a literature review and queried the PubMed database including abstracts from recent congresses. Search terms: ‘multiple myeloma', ‘proteasome inhibitors', ‘immunomodulatory drugs', ‘stem cell transplantation' and drug-related terms. Expert opinion: First-line treatment in younger, medically fit subjects should consist of induction, consolidation and maintenance elements to maximize response. Unfortunately, ‘personalized' approaches are far behind us as druggable genetic changes yet need to be identified.