Multiple myeloma is a cancer of plasma cells in the bone marrow that has seen significant advances in treatment over recent years1 . Today, patients have access to a variety of therapies that can extend survival and improve quality of life, although the disease remains incurable2 . New drug combinations, immunotherapies, and personalized approaches are transforming management strategies and offering hope for longer remission periods1 2.
Induction Therapy
Induction therapy is the initial phase of treatment for newly diagnosed multiple myeloma, aiming to rapidly reduce the myeloma burden and prepare patients for further therapy1 . This phase typically involves combination regimens of three or four drugs administered over multiple cycles3 . Quadruplet regimens, which add an anti-CD38 monoclonal antibody such as daratumumab to a triplet backbone of bortezomib, lenalidomide, and dexamethasone, are now recommended as standard first-line therapy for both transplant-eligible and ineligible patients3 .
"CAR T-cell treatment is one of the best therapies that science has produced. Imagine a patient who has been on multiple myeloma therapy on a regular basis for years, and they can now have a treatment-free holiday and long-lasting disease control for several months or even years. That's very exciting for these patients."
— Shahzad Raza, MD, Cleveland Clinic5
The choice of induction therapy is individualized based on patient characteristics, disease biology, and risk stratification1 . Standard regimens combine:
- Immunomodulatory drugs (IMiDs) like lenalidomide and pomalidomide, which enhance immune surveillance and exert direct anti-myeloma effects1 .
- Proteasome inhibitors such as bortezomib, carfilzomib, and ixazomib, which block protein degradation, causing toxic protein buildup and apoptosis in myeloma cells1 .
- Corticosteroids like dexamethasone, which reduce inflammation and tumor burden1 .
Recent clinical trials have demonstrated that adding anti-CD38 antibodies to these combinations improves response rates and delays disease progression3 . Risk-adapted therapy, guided by genetic and clinical factors, is emphasized by both the European Myeloma Network and NCCN guidelines to optimize outcomes1 4.
The four-drug regimen of daratumumab, bortezomib, lenalidomide, and dexamethasone in the frontline setting significantly reduces the chance of early relapse, improving progression-free survival5 .
Stem Cell Transplant
Autologous stem cell transplantation (ASCT) remains a cornerstone of treatment for eligible multiple myeloma patients after induction therapy1 . ASCT uses the patient’s own stem cells, collected and cryopreserved before administering high-dose chemotherapy to eradicate residual myeloma cells1 . The reinfusion of stem cells restores bone marrow function and hematopoiesis, allowing recovery from intensive treatment1 .
The transplant process includes:
- Stem cell collection from the patient’s blood and cryopreservation1 .
- Administration of high-dose chemotherapy to eliminate remaining cancer cells1 .
- Reinfusion of the collected stem cells to repopulate the bone marrow1 .
Recovery from ASCT typically takes several months and may involve side effects such as taste changes, mucositis (mouth sores), and fatigue1 . While ASCT improves progression-free survival, its impact on overall survival is less clear1 .
Non-transplant-eligible patients, often due to age or comorbidities, receive extended induction and maintenance therapy instead, sometimes up to 12 cycles of treatment1 . Both the NCCN and European Myeloma Network provide detailed criteria for patient selection and management1 4.
