Multiple Myeloma
An Introduction to Multiple Myeloma
Multiple myeloma (MM) is an incurable B-cell-derived haematological malignancy originating from the proliferation of long-lived plasma cells in the bone marrow This leads to bone marrow failure and subsequent anaemia, immune paresis and infection, bone pain and fractures, high calcium levels and kidney failure. Drug resistance is an emerging issue in the treatment of MM, as many patients become refractory to treatment. Histone deacetylase inhibitors are currently an available treatment option for MM due to the well characterized role that genetics and epigenetics play in drug resistance. Other common drug classes used include alkylating agents and anthracyclines, proteasome inhibitors, monoclonal antibodies and corticosteroids; however, due to the increased doses of corticosteroids required for treating MM compared with other conditions, the side effect profile is substantial, particularly in older patients. Following an initial induction combination therapy, autologous stem cell transplantation is often the next step in MM treatment. Future treatment directions are centred around targeted immunotherapies, such as chimeric antigen receptor (CAR) T-cell therapy, which was approved in 2021 for patients with relapsed/refractory disease after receiving four or more prior lines of treatment. Novel CAR T-cell therapy targets are under investigation to mitigate issues with resistance and relapse, with data from a phase I clinical trial of bispecific CAR T-cell therapy targeting B-cell maturation antigen and CD38 showing promise.
