Szpiczak mnogi – Leczenie

Szpiczak mnogi
Leczenie

Szpiczak mnogi jest złośliwym nowotworem komórek plazmatycznych szpiku kostnego, charakteryzującym się obecnie pięcioletnim przeżyciem powyżej 62% i medianą przeżycia wydłużoną do ponad 7 lat. Leczenie obejmuje wieloetapową terapię indukcyjną (3-4 cykle, każdy trwający 3-4 tygodnie) z zastosowaniem schematów trój- lub czterolekowych, w tym kombinacji inhibitorów proteasomu (bortezomib, karfilzomib, iksazomib), leków immunomodulujących (lenalidomid, talidomid, pomalidomid), kortykosteroidów (deksametazon) oraz przeciwciał monoklonalnych (daratumumab, izatuksymab). U kwalifikujących się pacjentów stosuje się autologiczny przeszczep komórek macierzystych (ASCT) po wysokodawkowej chemioterapii melfalanem, co znacząco poprawia odpowiedź na leczenie. Terapia podtrzymująca, najczęściej lenalidomidem w połączeniu z inhibitorem proteasomu lub daratumumabem, wydłuża czas odpowiedzi, choć wiąże się z ryzykiem wtórnych nowotworów. Nowoczesne immunoterapie, takie jak przeciwciała dwuswoiste (teklistamab, elranatamab, talkwetamab) oraz terapie CAR-T (idecabtagene vicleucel, ciltacabtagene autoleucel), stanowią przełom w leczeniu nawrotowego i opornego szpiczaka, oferując długotrwałą kontrolę choroby.

Wprowadzenie do leczenia szpiczaka mnogiego

Szpiczak mnogi (multiple myeloma) jest nowotworem złośliwym wywodzącym się z komórek plazmatycznych szpiku kostnego. Mimo że obecnie nie istnieje metoda pozwalająca na całkowite wyleczenie tej choroby, w ostatnich dwóch dekadach nastąpił znaczący postęp w jej leczeniu, co przełożyło się na wydłużenie czasu przeżycia pacjentów i poprawę jakości ich życia. Obecnie pięcioletnie przeżycie w szpiczaku mnogim wynosi ponad 62%, a mediana przeżycia wydłużyła się z 2,5 lat przed 1997 rokiem do ponad 7 lat obecnie¹².

Główne cele leczenia szpiczaka mnogiego obejmują:

Redukcję ilości białka monoklonalnego lub łańcuchów lekkich do najniższego możliwego poziomu
Eliminację komórek szpiczakowych ze szpiku kostnego
Poprawę jakości życia z minimalizacją działań niepożądanych leczenia
Zapewnienie jak najdłuższego okresu odpowiedzi przed pierwszym nawrotem
Wydłużenie całkowitego czasu przeżycia³

Standardowe podejście terapeutyczne

Leczenie szpiczaka mnogiego jest zazwyczaj prowadzone w kilku etapach i obejmuje:

Terapia indukcyjna (pierwsza linia leczenia)

Terapia indukcyjna, nazywana również terapią pierwszej linii, stanowi podstawę leczenia objawowego szpiczaka mnogiego. Standardowo składa się z kombinacji trzech lub czterech leków podawanych przez 3-4 cykle, z których każdy trwa zazwyczaj 3-4 tygodnie⁴. Wybór początkowego leczenia zależy od wielu czynników, w tym od stanu zdrowia pacjenta, wieku, chorób współistniejących oraz kwalifikacji do przeszczepu komórek macierzystych.

Najczęściej stosowane schematy indukcyjne to:

Trójlekowe:
- Bortezomib, lenalidomid i deksametazon (VRd)
- Bortezomib, cyklofosfamid i deksametazon (VCd)
- Karfilzomib, lenalidomid i deksametazon (KRd)
Czterolekowe:
- Daratumumab, bortezomib, lenalidomid i deksametazon (D-VRd)
- Daratumumab, bortezomib, talidomid i deksametazon (D-VTd)
- Izatuksymab, bortezomib, lenalidomid i deksametazon

W przypadku pacjentów kwalifikujących się do przeszczepu, po 3-4 cyklach terapii indukcyjnej przeprowadza się mobilizację i pobranie komórek macierzystych, po czym następuje wysokodawkowa chemioterapia i auto-HSCT (autologiczny przeszczep krwiotwórczych komórek macierzystych)⁵. Według najnowszych badań, schematy czterolekowe zawierające daratumumab znacząco poprawiają wyniki leczenia – w badaniu PERSEUS, po okresie obserwacji wynoszącym prawie 4 lata, 84% pacjentów w grupie leczonej daratumumabem wciąż żyło bez progresji choroby, w porównaniu do 68% pacjentów, którzy otrzymali tylko standardowe leczenie⁶.

Konsolidacja i przeszczep komórek macierzystych

Autologiczny przeszczep komórek macierzystych (ASCT) pozostaje standardem postępowania dla kwalifikujących się pacjentów po terapii indukcyjnej. Procedura obejmuje pobranie własnych komórek macierzystych pacjenta przed podaniem wysokodawkowej chemioterapii (najczęściej melfalanu), a następnie ich ponowne wprowadzenie w celu odbudowy szpiku kostnego⁷.

Przeszczep nie leczy szpiczaka mnogiego całkowicie, ale prowadzi do znaczącej i długotrwałej odpowiedzi. W porównaniu z samą chemioterapią, ASCT z większym prawdopodobieństwem wywołuje znaczącą i długotrwałą odpowiedź na leczenie⁸. U niektórych pacjentów, szczególnie z szpiczakiem mnogim o wysokim ryzyku, rozważa się podwójny (tandemowy) przeszczep wykonywany w odstępie 6-12 miesięcy⁹¹⁰.

Po przeszczepie można zastosować krótkotrwałą terapię konsolidacyjną, której celem jest pogłębienie odpowiedzi uzyskanej po ASCT¹¹.

Terapia podtrzymująca

Terapia podtrzymująca ma na celu utrzymanie odpowiedzi na leczenie przez jak najdłuższy czas. Badania kliniczne wykazały wyraźne korzyści z terapii podtrzymującej w zakresie zarówno czasu trwania odpowiedzi na leczenie, jak i długoterminowych wyników dla pacjentów¹².

Lenalidomid jest preferowanym lekiem w terapii podtrzymującej po przeszczepie, na podstawie wyników kilku badań klinicznych. Nie powoduje neurotoksyczności charakterystycznej dla innych leków immunomodulujących, takich jak talidomid¹³. Jednak lenalidomid wydaje się zwiększać ryzyko rozwoju wtórnego nowotworu podczas terapii podtrzymującej, szczególnie po przeszczepie lub po terapii schematem zawierającym melfalan.

Po przeszczepie zazwyczaj stosuje się dwa leki jako terapię podtrzymującą, typowo lenalidomid w połączeniu z inhibitorem proteasomu lub w niektórych przypadkach daratumumabem¹⁴. Terapia podtrzymująca bortezomibem lub iksazomibem jest zalecana dla pacjentów z określonymi nieprawidłowościami cytogenetycznymi¹⁵.

Klasy leków stosowanych w leczeniu szpiczaka mnogiego

Inhibitory proteasomu

Inhibitory proteasomu stanowią ważną klasę leków w leczeniu szpiczaka mnogiego i są stosowane na wszystkich etapach choroby¹⁶. Działają poprzez blokowanie proteasomów – kompleksów enzymatycznych, które rozkładają nieprawidłowe białka w komórkach. Blokowanie proteasomów prowadzi do gromadzenia się białek wewnątrz komórek szpiczakowych, co powoduje ich śmierć¹⁷.

Najczęściej stosowane inhibitory proteasomu to:

Bortezomib (Velcade) – pierwszy inhibitor proteasomu zatwierdzony do leczenia szpiczaka. Wykazuje wysoką skuteczność w terapii szpiczaka i jest standardowym składnikiem wielu schematów leczenia¹⁸.
Karfilzomib (Kyprolis) – stosowany w leczeniu szpiczaka nawrotowego lub opornego na leczenie¹⁹.
Iksazomib (Ninlaro) – pierwszy doustny inhibitor proteasomu, stosowany w leczeniu nawrotowego lub opornego szpiczaka mnogiego²⁰.

Główne działania niepożądane inhibitorów proteasomu obejmują neuropatię obwodową (szczególnie w przypadku bortezomibu), zmęczenie, małopłytkowość, neutropenię oraz zaburzenia żołądkowo-jelitowe²¹.

Leki immunomodulujące (IMiDs)

Leki immunomodulujące wpływają na układ odpornościowy, chociaż dokładny mechanizm ich działania nie jest w pełni wyjaśniony. Leki te są często pomocne w leczeniu szpiczaka mnogiego²². Działają poprzez zakłócanie wzrostu i podziału komórek szpiczakowych²³.

Główne leki z tej grupy to:

Lenalidomid (Revlimid) – jeden z najczęściej stosowanych leków w leczeniu szpiczaka. Jest standardowym składnikiem wielu schematów leczenia oraz preferowanym lekiem w terapii podtrzymującej²⁴.
Talidomid (Thalomid) – pierwszy lek z tej klasy, wprowadzony do leczenia szpiczaka w 1999 roku. Ze względu na działania niepożądane (neuropatia) jest obecnie rzadziej stosowany²⁵.
Pomalidomid (Pomalyst) – trzeci lek z tej grupy, stosowany głównie w leczeniu nawrotowego/opornego szpiczaka mnogiego²⁶.

Leki immunomodulujące zwiększają ryzyko zakrzepicy, dlatego często są podawane razem z aspiryną lub lekiem przeciwzakrzepowym²⁷. Inne działania niepożądane obejmują neutropenię, zmęczenie i zaparcia.

Przeciwciała monoklonalne

Przeciwciała monoklonalne to sztucznie wytworzone przeciwciała zaprojektowane do rozpoznawania i atakowania specyficznych białek na powierzchni komórek szpiczakowych. Działają zarówno poprzez bezpośrednie niszczenie komórek nowotworowych, jak i wspomaganie układu odpornościowego w ich atakowaniu²⁸.

Najważniejsze przeciwciała monoklonalne stosowane w leczeniu szpiczaka to:

Daratumumab (Darzalex) – przeciwciało skierowane przeciwko antygenowi CD38 na powierzchni komórek szpiczakowych. Jest stosowany zarówno w pierwszej linii leczenia, jak i w nawrotowym/opornym szpiczaku²⁹.
Izatuksymab (Sarclisa) – również skierowany przeciwko antygenowi CD38, stosowany w leczeniu nawrotowego/opornego szpiczaka³⁰.
Elotuzumab (Empliciti) – przeciwciało skierowane przeciwko białku SLAMF7, stosowane w połączeniu z innymi lekami w leczeniu nawrotowego szpiczaka³¹.
Talkwetamab (Talvey) – przeciwciało monoklonalne, które może być stosowane w leczeniu nawrotowego lub opornego szpiczaka mnogiego po co najmniej 3 innych terapiach³².

W sierpniu 2023 roku FDA przyznała przyspieszoną aprobatę dla przeciwciała GPRC5D-ukierunkowanego dwuswoistego o nazwie talkwetamab u pacjentów z opornymi postaciami szpiczaka mnogiego³³.

Przeciwciała dwuswoiste (bispecific antibodies)

Przeciwciała dwuswoiste to nowa klasa immunoterapeutyków, które wiążą się jednocześnie z dwoma różnymi antygenami – jednym na komórkach T, a drugim na komórkach nowotworowych. Dzięki temu działają jako pomost między układem odpornościowym a komórkami szpiczakowymi, co prowadzi do niszczenia tych ostatnich³⁴.

Do niedawno zatwierdzonych dwuswoistych przeciwciał należą:

Teklistamab (Tecvayli) – w październiku 2022 roku FDA zatwierdziła to przeciwciało dwuswoiste skierowane przeciwko BCMA dla osób z szpiczakiem mnogim, u których wcześniejsze terapie nie zadziałały³⁵.
Elranatamab (Elrexfio) – w sierpniu 2023 roku FDA przyznała przyspieszoną aprobatę dla tego przeciwciała dwuswoistego skierowanego przeciwko BCMA u pacjentów z szpiczakiem mnogim, u których wcześniejsze terapie nie zadziałały³⁶.

Terapia przeciwciałami dwuswoistymi jest bardziej dostępna dla pacjentów i wymaga mniej czasu niż terapia CAR-T, która wymaga tygodni na pobranie, zaprojektowanie i wyprodukowanie komórek T pacjenta³⁷.

Kortykosteroidy

Kortykosteroidy stanowią ważną klasę leków w leczeniu szpiczaka mnogiego i są stosowane na wszystkich etapach choroby³⁸. Pomagają zniszczyć komórki szpiczakowe i zwiększają skuteczność chemioterapii³⁹.

Najczęściej stosowane kortykosteroidy to:

Deksametazon – silny kortykosteroid, stanowiący podstawowy składnik większości schematów leczenia szpiczaka⁴⁰.
Prednizon – stosowany w niektórych schematach leczenia, szczególnie w połączeniu z melfalanem⁴¹.

Typowe działania niepożądane kortykosteroidów obejmują: wysokie stężenie glukozy we krwi, zwiększony apetyt i przyrost masy ciała, problemy ze snem oraz zmiany nastroju, takie jak drażliwość lub pobudzenie⁴².

Chemioterapia

Chemioterapia używa leków, które zabijają komórki znajdujące się w procesie podziału. W przeszłości była główną metodą leczenia szpiczaka mnogiego, ale obecnie jej rola została częściowo zastąpiona przez nowsze klasy leków⁴³.

Najczęściej stosowane leki chemioterapeutyczne w leczeniu szpiczaka to:

Melfalan – lek alkilujący, historycznie stanowiący podstawę leczenia szpiczaka. Stosowany w wysokich dawkach przed przeszczepem komórek macierzystych⁴⁴.
Cyklofosfamid – lek alkilujący, często stosowany w połączeniu z innymi lekami w schematach leczenia szpiczaka⁴⁵.
Doksorubicyna – antracyklina, stosowana w niektórych schematach leczenia szpiczaka⁴⁶.

Działania niepożądane chemioterapii obejmują nudności, wymioty, utratę włosów, zmęczenie, zwiększone ryzyko infekcji oraz uszkodzenie szpiku kostnego⁴⁷.

Zaawansowane metody leczenia szpiczaka mnogiego

Terapia CAR-T

Terapia CAR-T (Chimeric Antigen Receptor T-cell) to nowatorska forma immunoterapii, która wykorzystuje własne białe krwinki pacjenta do walki ze szpiczakiem⁴⁸. Polega na pobraniu komórek T pacjenta, modyfikacji ich w laboratorium w celu rozpoznawania i atakowania komórek szpiczakowych, a następnie ponownym wprowadzeniu ich do organizmu⁴⁹.

Obecnie FDA zatwierdziła dwie terapie CAR-T do leczenia szpiczaka mnogiego:

Idecabtagene vicleucel (Abecma) – przeprogramowuje własne komórki T pacjenta do identyfikacji i niszczenia receptorów BCMA (antygenu dojrzewania komórek B) na powierzchni komórek szpiczakowych⁵⁰.
Ciltacabtagene autoleucel (Carvykti) – jest terapią immunologiczną z genetycznie zmodyfikowanymi autologicznymi komórkami T, która kieruje komórki CAR-dodatnie do eliminacji komórek wykazujących ekspresję BCMA⁵¹.

Terapia CAR-T wykazuje wysoką skuteczność u pacjentów z nawrotowym/opornym szpiczakiem mnogim. Jedną z głównych zalet tej terapii jest to, że jest to leczenie jednorazowe, więc istnieje określony czas, w którym pacjent musi przebywać poza domem⁵². Jednak produkcja komórek CAR-T zajmuje od sześciu do ośmiu tygodni, co stanowi pewne ograniczenie⁵³.

Potencjalne działania niepożądane terapii CAR-T mogą być poważne i obejmują zespół uwalniania cytokin (CRS), problemy z układem nerwowym oraz infekcje⁵⁴.

Cilta-cel – nowa era w leczeniu szpiczaka mnogiego

Cilta-cel (ciltacabtagene autoleucel) jest zaawansowaną terapią komórkową, zaprojektowaną specjalnie do celowania w antygen dojrzewania komórek B (BCMA) na powierzchni złośliwych komórek plazmatycznych, co czyni ją szczególnie skuteczną w leczeniu nowotworów z komórek B, takich jak szpiczak mnogi⁵⁵.

Przełomowym osiągnięciem związanym z cilta-cel jest jego zdolność do indukowania ujemnego stanu minimalnej choroby resztkowej (MRD). Dla pacjentów z nawrotowym szpiczakiem mnogim wyniki te mogą być transformujące⁵⁶.

Oprócz obiecujących początkowych wyników, długoterminowe dane z cilta-cel wykazały znaczące korzyści. Dla pacjentów w podeszłym wieku, którzy nie kwalifikują się do agresywnych lub ciągłych terapii, cilta-cel może oferować możliwość życia bez aktywności choroby przez dłuższe okresy⁵⁷.

Obecnie trwają badania nad zastosowaniem cilta-cel we wcześniejszych liniach terapii, nie tylko u pacjentów z nawrotem, ale także u pacjentów z nowo zdiagnozowanym szpiczakiem mnogim⁵⁸.

Radioterapia

Radioterapia, która wykorzystuje cząstki lub promienie o wysokiej energii do uszkodzenia komórek nowotworowych i zapobiegania ich wzrostowi, okazała się skuteczna w leczeniu powikłań choroby kostnej spowodowanej szpiczakiem⁵⁹.

Radioterapia jest stosowana w szpiczaku mnogim głównie w celu:

Leczenia bólu kostnego
Stabilizacji kości zagrożonych złamaniem
Leczenia ucisku rdzenia kręgowego
Leczenia ogniskowych zmian nowotworowych⁶⁰

Radioterapia jest często stosowana jako leczenie paliatywne w celu złagodzenia objawów szpiczaka mnogiego, szczególnie bólu związanego z uszkodzeniem kości⁶¹.

Leczenie nawrotowego i opornego szpiczaka mnogiego

Pomimo postępów w leczeniu, szpiczak mnogi pozostaje chorobą nieuleczalną, a nawroty są częste. Jeśli szpiczak mnogi jest oporny na terapię (oporny) lub jeśli powraca po początkowej odpowiedzi na leczenie (nawrotowy), mówimy o nawrotowym lub opornym szpiczaku mnogim⁶².

Istnieje wiele skutecznych opcji leczenia nawrotowego szpiczaka, a kolejne są testowane w badaniach klinicznych. Dlatego w przypadku nawrotu szpiczaka nie należy tracić nadziei ani myśleć, że nie ma szans na skuteczne leczenie⁶³.

Główne opcje leczenia nawrotowego/opornego szpiczaka mnogiego obejmują:

Leki immunomodulujące: lenalidomid, pomalidomid, talidomid
Inhibitory proteasomu: bortezomib, karfilzomib, iksazomib
Kortykosteroidy: deksametazon
Przeciwciała monoklonalne: daratumumab, elotuzumab, izatuksymab
Przeciwciała dwuswoiste: teklistamab, elranatamab, talkwetamab
Inhibitory eksportu jądrowego: selineksor
Leki cytotoksyczne: melfalan, cyklofosfamid
Terapia CAR-T
Autologiczny przeszczep komórek macierzystych⁶⁴

Jeśli nawrót występuje ponad 6 miesięcy po zakończeniu początkowej terapii, można ponownie zastosować początkowo skuteczny schemat leczenia⁶⁵. W przeciwnym razie zaleca się wykorzystanie leków z innych klas lub nowszych generacji.

Leczenie wspomagające w szpiczaku mnogim

Oprócz otrzymywania leczenia skierowanego bezpośrednio na chorobę, pacjenci będą najprawdopodobniej wymagać dodatkowego leczenia, aby pomóc w zarządzaniu objawami i działaniami niepożądanymi leczenia⁶⁶.

Leczenie choroby kostnej

Choroba kostna jest częstym powikłaniem szpiczaka mnogiego, dotykającym 80-90% pacjentów i obejmującym ból kości, złamania patologiczne (40%), ucisk rdzenia kręgowego (5%) i hiperkalcemię⁶⁷.

Leki stosowane w zapobieganiu i leczeniu zdarzeń związanych z układem kostnym (SRE) u pacjentów ze szpiczakiem mnogim obejmują bisfosfoniany: kwas zoledronowy i pamidronian, oraz przeciwciało monoklonalne denosumab⁶⁸.

Dożylne bisfosfoniany (kwas zoledronowy lub pamidronian) są zalecane dla wszystkich pacjentów ze szpiczakiem mnogim, którzy otrzymują leczenie, niezależnie od obecności zmian kostnych⁶⁹. Działają one jako specyficzne inhibitory aktywności osteoklastów i są stosowane w leczeniu resorpcji kostnej⁷⁰.

Martwica kości szczęki jest rzadkim, ale poważnym działaniem niepożądanym terapii bisfosfonianami⁷¹.

Profilaktyka przeciwzakrzepowa

Bez profilaktyki zdarzenia zakrzepowo-zatorowe są niezwykle częste u pacjentów ze szpiczakiem mnogim, szczególnie u tych otrzymujących leki immunomodulujące⁷². Dlatego istotne jest stosowanie odpowiedniej profilaktyki przeciwzakrzepowej.

Pacjenci otrzymujący leki immunomodulujące (talidomid, lenalidomid, pomalidomid) powinni otrzymywać profilaktykę przeciwzakrzepową w postaci aspiryny lub leków przeciwzakrzepowych⁷³.

Profilaktyka przeciwinfekcyjna

Pacjenci ze szpiczakiem mnogim są szczególnie narażeni na infekcje, zwłaszcza wywołane przez bakterie otoczkowe⁷⁴. Zaleca się szczepienia przeciwko grypie i pneumokokom⁷⁵.

W niektórych sytuacjach zalecane są profilaktyczne antybiotyki, w tym stosowanie trimetoprimu/sulfametoksazolu lub fluorochinolonu przez pierwsze trzy miesiące leczenia⁷⁶.

Leczenie niedokrwistości

Pacjenci ze szpiczakiem mnogim często rozwijają niedokrwistość. Leki stymulujące erytropoezę mogą zwiększyć liczbę czerwonych krwinek we krwi, co może pomóc w złagodzeniu utrzymującej się niedokrwistości⁷⁷.

Jednak należy pamiętać, że stosowanie czynników stymulujących erytropoezę zmniejsza potrzebę transfuzji krwinek czerwonych, ale zwiększa ryzyko powikłań zakrzepowo-zatorowych i śmierci⁷⁸.

Nowe kierunki w leczeniu szpiczaka mnogiego

Badania nad nowymi metodami leczenia szpiczaka mnogiego są intensywnie prowadzone na całym świecie. Oto niektóre z obiecujących kierunków:

Alogeniczne produkty CAR-T, które mogłyby być dostępne od ręki, eliminując czasochłonny proces produkcji autologicznych produktów CAR-T⁷⁹.
CELMoDs (Cereblon E3 Ligase Modulatory Drugs), takie jak iberdomid i megzidomid, które są obecnie testowane w badaniach klinicznych⁸⁰.
Nowe kombinacje leków, w tym schematy zawierające inhibitory kinaz lub epigenetyczne modulatory⁸¹.
Terapie celowane oparte na specyficznych zmianach genetycznych w komórkach szpiczakowych⁸².

Prowadzone są również badania nad wczesną interwencją u pacjentów z szpiczakiem tlącym się (SMM), aby zapobiec progresji do pełnoobjawowego szpiczaka mnogiego. Badanie przeprowadzone przez grupę PETHEMA wykazało korzyści z leczenia lenalidomidem u pacjentów z SMM wysokiego ryzyka. Po medianie obserwacji wynoszącej 40 miesięcy, pacjenci, którzy zostali zrandomizowani do leczenia indukcyjnego lenalidomidem i deksametazonem, a następnie leczenia podtrzymującego lenalidomidem, wykazali znacząco wydłużony czas do progresji (mediana nie osiągnięta vs 21 miesięcy) i wyższy wskaźnik 3-letniego przeżycia (94% vs 80%)⁸³.

Podsumowanie

Leczenie szpiczaka mnogiego przeszło znaczącą ewolucję w ciągu ostatnich dwóch dekad. Od historycznego standardu opartego na melfalanie i prednizonie, terapia przesunęła się w kierunku złożonych schematów wielolekowych, obejmujących inhibitory proteasomu, leki immunomodulujące, przeciwciała monoklonalne, oraz nowatorskie terapie, takie jak CAR-T.

Chociaż szpiczak mnogi nadal jest uważany za chorobę nieuleczalną, współczesne metody leczenia pozwalają na długotrwałą kontrolę choroby i znaczące wydłużenie życia pacjentów. W wielu przypadkach szpiczak mnogi stał się chorobą przewlekłą, z którą pacjenci mogą żyć przez wiele lat, utrzymując dobrą jakość życia.

Trwające badania kliniczne nad nowymi lekami i kombinacjami dają nadzieję na dalszą poprawę wyników leczenia, a w przyszłości potencjalnie nawet na opracowanie metod terapeutycznych prowadzących do wyleczenia tej choroby.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Multiple Myeloma: Improved Prognosis With the Latest Treatments | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/multiple-myeloma-improved-prognosis-latest-treatments
Saad Usmani, Chief of MSK’s Myeloma Service, says there are far more treatment options for multiple myeloma today compared with just 20 years ago. […] Multiple myeloma is currently not curable, but we can manage the disease effectively for years. For active myeloma, treatment may include chemotherapy, proteasome inhibitors, immune-modifying drugs or other medications, or stem cell transplantation. Treatments can bring the disease into remission, but it often returns. […] We have made a great deal of progress in the past two decades, thanks to the development of more effective drugs. The overall five-year survival rate for people with active multiple myeloma in the United States has increased steadily over time, to more than 62% today. […] There are several types of new multiple myeloma drugs that have been developed over the past two decades.
#2 Multiple Myeloma: Available Therapies and Causes of Drug Resistance
https://pmc.ncbi.nlm.nih.gov/articles/PMC7072128/
The use and optimization of combinations of these drugs allowed improving the overall survival of MM patients; the median survival was of 2.5 years prior to 1997, 4 years in the following decade and over 7 years more recently. […] However, resistance to these agents has been observed and MM patients who became refractory to both first generation IMIDs and PIs have significant worse outcomes. […] Furthermore, next generation IMIDs and PIs were developed and introduced in the therapy of relapsed and refractory patients, and more recently, regimens combining the use of mAbs and iHDACs were also approved for MM treatment. […] Consequently, the selection of the primary treatment has changed over time. […] Patients are usually stratified by age, performance status and comorbidities, in order to evaluate potential candidates for ASCT.
#3 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
As a multiple myeloma patient, it’s important to start the right treatment plan quickly to increase your chances of achieving your best outcome. […] There is no cure for multiple myeloma; however, there are many treatment options (with new ones emerging every year) to effectively manage the disease. […] The standard of care for newly diagnosed multiple myeloma is called induction therapy, followed by an autologous stem cell transplant (if eligible) and maintenance therapy; collectively, these are considered one line of therapy. […] The goals of multiple myeloma treatment include reducing the amount of M protein or light chains to the lowest level possible, eliminating myeloma cells from the bone marrow, improving quality of life with as few treatment side effects as possible, providing the longest possible period of response before first relapse, and prolonging overall survival.
#4 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
Induction therapy, or front-line therapy, typically consists of a three-drug or four-drug combination regimen given over three to four cycles, each of which typically lasts 3 or 4 weeks. […] The choice of initial treatment depends on many factors. […] If you are a candidate for transplant, you may choose to have a transplant after three or four cycles of induction therapy or you may decide to complete induction therapy and consider transplant later. […] If you are eligible and decide to proceed with a transplant, you will usually receive induction therapy followed by stem cell collection and storage, high-dose melphalan chemotherapy, and ASCT. […] After induction and autologous stem cell transplant, you will undergo maintenance (continuous) therapy. […] Maintenance therapy improves survival and can increase the length of time you spend in remission, but it is also associated with treatment side effects.
#5 Patient education: Multiple myeloma treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics
While it does not cure the disease, autologous stem cell transplant can lead to significant and prolonged responses in multiple myeloma. […] „CAR-T” therapy â CAR-T therapy is a form of immunotherapy. It uses the person’s own immune system to target a specific antigen (a type of protein) found on the surface of the cancer cells. […] The initial choice of therapy depends on the person’s health, age, frailty, eligibility for stem cell transplantation, and the aggressiveness of the cancer (whether the disease is considered high risk or standard risk). […] Most people will be treated with a three-drug regimen that includes: An immunomodulatory drug such as lenalidomide (brand name: Revlimid), A corticosteroid such as dexamethasone, and Either a proteasome inhibitor such as bortezomib (brand name: Velcade) or the monoclonal antibody daratumumab (brand name: Darzalex).
#6 Darzalex Faspro, Sarclisa Approvals for Multiple Myeloma – NCI
https://www.cancer.gov/news-events/cancer-currents-blog/2025/fda-daratumumab-isatuximab-newly-diagnosed-myeloma
VRd has been the preferred treatment for people with newly diagnosed disease who are eligible for a transplant. […] After a median follow-up of nearly 4 years, 84% of people in the daratumumab group were still alive without their cancer getting worse, compared with 68% of those who only received the standard treatment. […] A greater number of people who received daratumumab had a complete response, meaning they showed no signs of cancer on standard tests. […] Isatuximabs approval was based on results from a large clinical trial called IMROZ, funded by Sanofi, the drugs maker. […] After nearly 5 years of follow-up, 63% of people in the isatuximab group were alive without their cancer getting worse, compared with 45% in the standard treatment group. […] Although multiple myeloma is considered incurable, advances in treatment have led to longer remissions and longer overall survival.
#7 6 Innovative Multiple Myeloma Treatment Options | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/multiple-myeloma/multiple-myeloma-treatment.html
Immunotherapy is one of several innovative targeted therapies performed by MDAnderson. It uses your own immune cells to fight off cancer cells. […] Radiation therapy often plays a valuable role in providing quick pain relief and decreasing the risk of fractured bones. […] A stem cell transplant (or bone marrow transplant) replaces defective or damaged bone marrow cells with your own healthy blood-forming cells. […] High levels of abnormal proteins can lead to thickening of the blood. […] Autologous stem cell transplants are an option for patients whose cancer is in remission or has stabilized. This type of transplant is used most frequently to treat multiple myeloma and lymphoma. […] A successful autologous stem cell transplant helps many people with lymphoma or multiple myeloma become cancer-free or delays the cancers return. […] Most patients need only a single autologous transplant. Others, particularly those with multiple myeloma, may receive a planned second transplant several months after the first one. This is called a tandem transplant.
#8 Patient education: Multiple myeloma treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics/print
The best treatment option for people with high-risk multiple myeloma is not clear. […] For people who cannot or choose not to participate in a clinical trial, treatment depends on eligibility for autologous stem cell transplantation. […] For all people with multiple myeloma, the goal of therapy is to achieve a lasting response and prevent damage to the body related to myeloma. […] Autologous stem cell transplantation is a treatment option for some people with multiple myeloma. […] Autologous stem cell transplantation refers to transplantation with the person’s own stem cells. […] Compared with chemotherapy alone, autologous stem cell transplantation is more likely to produce a significant and prolonged response. […] Almost all people with multiple myeloma eventually relapse, and a small percentage are resistant to initial treatment.
#9 6 Innovative Multiple Myeloma Treatment Options | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/multiple-myeloma/multiple-myeloma-treatment.html
Immunotherapy is one of several innovative targeted therapies performed by MDAnderson. It uses your own immune cells to fight off cancer cells. […] Radiation therapy often plays a valuable role in providing quick pain relief and decreasing the risk of fractured bones. […] A stem cell transplant (or bone marrow transplant) replaces defective or damaged bone marrow cells with your own healthy blood-forming cells. […] High levels of abnormal proteins can lead to thickening of the blood. […] Autologous stem cell transplants are an option for patients whose cancer is in remission or has stabilized. This type of transplant is used most frequently to treat multiple myeloma and lymphoma. […] A successful autologous stem cell transplant helps many people with lymphoma or multiple myeloma become cancer-free or delays the cancers return. […] Most patients need only a single autologous transplant. Others, particularly those with multiple myeloma, may receive a planned second transplant several months after the first one. This is called a tandem transplant.
#10 Treatment for multiple myeloma
https://www.medicalnewstoday.com/articles/multiple-myeloma-treatments
Monoclonal antibodies are artificial versions of antibodies produced by the immune system. They attack a specific target, such as proteins on the surface of myeloma cells. […] Monoclonal antibodies that attach to the CD38 protein on myeloma cells include daratumumab (Darzalex) and isatuximab (Sarclisa). According to the American Cancer Society, these monoclonal antibodies kill cancer cells and help the immune system attack them. […] Proteasome inhibitors block the action of proteasomes in cancer cells. […] Proteasome inhibitors doctors may recommend for multiple myeloma include: bortezomib (Velcade), carfilzomib (Kyprolis), ixazomib (Ninlaro). […] A doctor may recommend a person have a stem cell transplant following chemotherapy. Chemotherapy kills cancer cells, but it also destroys healthy cells, such as blood-forming cells. A stem cell transplant replaces the blood-forming cells. […] Research indicates having two transplants 612 months apart may help people more than having a single transplant.
#11 How We Treat Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/treatment
Most people with multiple myeloma receive a combination of three or four drugs that may include a CD38-targeted monoclonal antibody, such as daratumumab; an immunomodulatory drug (IMID), such as lenalidomide; a proteasome inhibitor such as bortezomib; and a corticosteroid such as dexamethasone. […] Induction chemotherapy is typically administered over a period of four to eight months, and is followed by either treatment intensification with high-dose chemotherapy and autologous stem cell transplantation or maintenance therapy. […] After the initial treatment, maintenance therapy is often used to help keep the disease in remission for a longer time. […] Several clinical trials have shown a clear benefit for maintenance therapy in terms of the duration of response to treatment and long-term outcomes for patients.
#12 How We Treat Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/treatment
Most people with multiple myeloma receive a combination of three or four drugs that may include a CD38-targeted monoclonal antibody, such as daratumumab; an immunomodulatory drug (IMID), such as lenalidomide; a proteasome inhibitor such as bortezomib; and a corticosteroid such as dexamethasone. […] Induction chemotherapy is typically administered over a period of four to eight months, and is followed by either treatment intensification with high-dose chemotherapy and autologous stem cell transplantation or maintenance therapy. […] After the initial treatment, maintenance therapy is often used to help keep the disease in remission for a longer time. […] Several clinical trials have shown a clear benefit for maintenance therapy in terms of the duration of response to treatment and long-term outcomes for patients.
#13 Multiple Myeloma | Chemotherapy for Multiple Myeloma | LLS
https://www.lls.org/myeloma/treatment/chemotherapy-and-drug-therapy
Lenalidomide (Revlimid) is the preferred agent for post-transplant maintenance, based on the results of several clinical trials. It does not produce the neurotoxicity of other immunomodulatory drugs, such as thalidomide. However, lenalidomide appears to increase the risk for developing a secondary cancer during maintenance therapy, especially after transplantation or after therapy with a regimen that contains melphalan. […] Maintenance therapy with bortezomib (Velcade) or ixazomib (Ninlaro) is recommended for patients with certain cytogenetic abnormalities.
#14 Patient education: Multiple myeloma treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics
The best treatment option for people with high-risk multiple myeloma is not clear. […] For people who cannot or choose not to participate in a clinical trial, treatment depends on eligibility for autologous stem cell transplantation: People who are candidates for stem cell transplantation are often treated with a four-drug regimen such as DVRd or DVTd. […] Following transplant, two drugs are usually given for an extended time as „maintenance therapy,” typically lenalidomide in combination with a proteasome inhibitor, or in some instances daratumumab. […] For all people with multiple myeloma, the goal of therapy is to achieve a lasting response and prevent damage to the body related to myeloma. […] Autologous stem cell (bone marrow) transplantation is a treatment option for some people with multiple myeloma.
#15 Multiple Myeloma | Chemotherapy for Multiple Myeloma | LLS
https://www.lls.org/myeloma/treatment/chemotherapy-and-drug-therapy
Lenalidomide (Revlimid) is the preferred agent for post-transplant maintenance, based on the results of several clinical trials. It does not produce the neurotoxicity of other immunomodulatory drugs, such as thalidomide. However, lenalidomide appears to increase the risk for developing a secondary cancer during maintenance therapy, especially after transplantation or after therapy with a regimen that contains melphalan. […] Maintenance therapy with bortezomib (Velcade) or ixazomib (Ninlaro) is recommended for patients with certain cytogenetic abnormalities.
#16 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
If your multiple myeloma is resistant to therapy (refractory) or if your myeloma returns after an initial response to treatment (relapsed), you are said to have relapsed or refractory multiple myeloma. […] There are many effective treatment options for relapsed myeloma and more are being tested in clinical studies so if your myeloma relapses, you should not lose hope or think that there are no chances for an effective treatment. […] The main therapies for multiple myeloma involve the use of novel drugs called proteasome inhibitors, immunomodulatory drugs, antibodies, and B-cell maturation antigen (BCMA) targeted therapies, as well as the use of traditional drugs like steroids and chemotherapy. […] Proteasome inhibitors are an important class of multiple myeloma treatments and are used at all stages of disease.
#17
https://www.nhs.uk/conditions/multiple-myeloma/treatment/
Corticosteroids help destroy myeloma cells and make chemotherapy more effective. […] Thalidomide can help kill myeloma cells. […] Bortezomib (Velcade) can help kill myeloma cells by causing protein to build up inside them. […] Daratumumab helps kill the cancerous myeloma cells. […] People receiving intensive treatment are given a much higher dose of chemotherapy medicine as an inpatient to help destroy a larger number of myeloma cells. […] Further treatment is needed if myeloma returns. Treatment for relapses is similar to initial treatment, although non-intensive treatment is often preferred. […] Lenalidomide and pomalidomide are similar to thalidomide. […] Carfilzomib is a medicine similar to bortezomib. […] Ixazomib citrate (Ninlaro, Takeda) is used to treat multiple myeloma in adults who have had 2 or 3 other therapies.
#18
https://www.nhs.uk/conditions/multiple-myeloma/treatment/
Corticosteroids help destroy myeloma cells and make chemotherapy more effective. […] Thalidomide can help kill myeloma cells. […] Bortezomib (Velcade) can help kill myeloma cells by causing protein to build up inside them. […] Daratumumab helps kill the cancerous myeloma cells. […] People receiving intensive treatment are given a much higher dose of chemotherapy medicine as an inpatient to help destroy a larger number of myeloma cells. […] Further treatment is needed if myeloma returns. Treatment for relapses is similar to initial treatment, although non-intensive treatment is often preferred. […] Lenalidomide and pomalidomide are similar to thalidomide. […] Carfilzomib is a medicine similar to bortezomib. […] Ixazomib citrate (Ninlaro, Takeda) is used to treat multiple myeloma in adults who have had 2 or 3 other therapies.
#19 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Carfilzomib (Kyprolis) is a proteasome inhibitor that is sometimes used to treat multiple myeloma that has come back after treatment (called relapsed multiple myeloma) or no longer responds to treatment (called refractory multiple myeloma). […] Ixazomib (Ninlaro) is a proteasome inhibitor that is sometimes used to treat relapsed or refractory multiple myeloma. […] Immunomodulating drugs boost the immune system so they are also a type of immunotherapy. These drugs work by interfering with the growth and division of myeloma cells. […] Lenalidomide (Revlimid) is an immunomodulating drug and an anti-angiogenesis agent. […] Thalidomide (Thalomid) is an immunomodulating drug that is similar to lenalidomide. […] Pomalidomide (Pomalyst) is another immunomodulating drug similar to lenalidomide and thalidomide.
#20 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Carfilzomib (Kyprolis) is a proteasome inhibitor that is sometimes used to treat multiple myeloma that has come back after treatment (called relapsed multiple myeloma) or no longer responds to treatment (called refractory multiple myeloma). […] Ixazomib (Ninlaro) is a proteasome inhibitor that is sometimes used to treat relapsed or refractory multiple myeloma. […] Immunomodulating drugs boost the immune system so they are also a type of immunotherapy. These drugs work by interfering with the growth and division of myeloma cells. […] Lenalidomide (Revlimid) is an immunomodulating drug and an anti-angiogenesis agent. […] Thalidomide (Thalomid) is an immunomodulating drug that is similar to lenalidomide. […] Pomalidomide (Pomalyst) is another immunomodulating drug similar to lenalidomide and thalidomide.
#21 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Treatment with one of these drugs helps prevent further bone damage and events related to weakened bones such as fractures, hypercalcemia (high blood calcium levels), and spinal cord compression in people with multiple myeloma. […] Common side effects of corticosteroids can include: High blood sugar, Increased appetite and weight gain, Problems sleeping, Changes in mood, such as becoming irritable or hyper. […] Common side effects of TCEs include: Fever, Feeling very tired, Headache, Nausea, Diarrhea, Muscle and joint pain, Respiratory infections (including pneumonia), Low blood cell counts, Skin rash, Liver problems. […] Common side effects of selinexor include low platelet counts, low white blood cell counts, diarrhea, nausea, vomiting, not feeling hungry, weight loss, low blood sodium levels, and infections like bronchitis or pneumonia. […] Treatment with one of these drugs is often given for up to 2 years, after which the need for continuing it is reassessed. If the myeloma comes back and new bone problems develop, treatment with a bone-disease drug is usually started again.
#22 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Medicines are the main type of treatment for nearly everyone with multiple myeloma. This treatment could be a single drug or (more likely) several drugs used together. […] The drugs your cancer care team uses to treat your multiple myeloma will depend on many factors. […] A single drug might sometimes be used to treat multiple myeloma. But most often, 2 to 4 different kinds of drugs are combined because this tends to work better. The choice of which drugs to use depends on many factors, including: […] Immunomodulatory drugs (IMiDs) affect the immune system, although exactly how they do this isn’t entirely clear. These drugs are often helpful in treating multiple myeloma. […] IMiDs are taken daily as pills, with breaks from treatment on certain days each month. Because these drugs can increase the risk of serious blood clots, they are often given along with aspirin or a blood thinner.
#23 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Carfilzomib (Kyprolis) is a proteasome inhibitor that is sometimes used to treat multiple myeloma that has come back after treatment (called relapsed multiple myeloma) or no longer responds to treatment (called refractory multiple myeloma). […] Ixazomib (Ninlaro) is a proteasome inhibitor that is sometimes used to treat relapsed or refractory multiple myeloma. […] Immunomodulating drugs boost the immune system so they are also a type of immunotherapy. These drugs work by interfering with the growth and division of myeloma cells. […] Lenalidomide (Revlimid) is an immunomodulating drug and an anti-angiogenesis agent. […] Thalidomide (Thalomid) is an immunomodulating drug that is similar to lenalidomide. […] Pomalidomide (Pomalyst) is another immunomodulating drug similar to lenalidomide and thalidomide.
#24 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Carfilzomib (Kyprolis) is a proteasome inhibitor that is sometimes used to treat multiple myeloma that has come back after treatment (called relapsed multiple myeloma) or no longer responds to treatment (called refractory multiple myeloma). […] Ixazomib (Ninlaro) is a proteasome inhibitor that is sometimes used to treat relapsed or refractory multiple myeloma. […] Immunomodulating drugs boost the immune system so they are also a type of immunotherapy. These drugs work by interfering with the growth and division of myeloma cells. […] Lenalidomide (Revlimid) is an immunomodulating drug and an anti-angiogenesis agent. […] Thalidomide (Thalomid) is an immunomodulating drug that is similar to lenalidomide. […] Pomalidomide (Pomalyst) is another immunomodulating drug similar to lenalidomide and thalidomide.
#25 Oral Therapies for Multiple Myeloma – touchONCOLOGY
https://touchoncology.com/multiple-myeloma/journal-articles/oral-therapies-for-multiple-myeloma/
The historical standard of care, cyclophosphamide and melphalan-based therapies, and their currently used regimens are also discussed, followed by current data from trials on each drug alone or with dexamethasone. Finally, all-oral combination regimens of these therapies are summarized. […] Thalidomide was the first drug in this class and was introduced for treatment of myeloma in 1999. […] Lenalidomide is the second drug of this class to be approved for use in patients with myeloma. It is currently used alone as maintenance therapy after autologous stem-cell transplant (ASCT) in patients with standard-risk, becoming a new benchmark for survival. […] Pomalidomide is the third IMiD to be introduced, which, in combination with dexamethasone, is active in patients with relapsed/refractory MM.
#26 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Carfilzomib (Kyprolis) is a proteasome inhibitor that is sometimes used to treat multiple myeloma that has come back after treatment (called relapsed multiple myeloma) or no longer responds to treatment (called refractory multiple myeloma). […] Ixazomib (Ninlaro) is a proteasome inhibitor that is sometimes used to treat relapsed or refractory multiple myeloma. […] Immunomodulating drugs boost the immune system so they are also a type of immunotherapy. These drugs work by interfering with the growth and division of myeloma cells. […] Lenalidomide (Revlimid) is an immunomodulating drug and an anti-angiogenesis agent. […] Thalidomide (Thalomid) is an immunomodulating drug that is similar to lenalidomide. […] Pomalidomide (Pomalyst) is another immunomodulating drug similar to lenalidomide and thalidomide.
#27 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Medicines are the main type of treatment for nearly everyone with multiple myeloma. This treatment could be a single drug or (more likely) several drugs used together. […] The drugs your cancer care team uses to treat your multiple myeloma will depend on many factors. […] A single drug might sometimes be used to treat multiple myeloma. But most often, 2 to 4 different kinds of drugs are combined because this tends to work better. The choice of which drugs to use depends on many factors, including: […] Immunomodulatory drugs (IMiDs) affect the immune system, although exactly how they do this isn’t entirely clear. These drugs are often helpful in treating multiple myeloma. […] IMiDs are taken daily as pills, with breaks from treatment on certain days each month. Because these drugs can increase the risk of serious blood clots, they are often given along with aspirin or a blood thinner.
#28 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Corticosteroids, such as dexamethasone and prednisone, are an important part of the treatment of multiple myeloma. They can be used alone or combined with other drugs as a part of treatment. […] Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells. […] Monoclonal antibodies that target this protein seem to work both by killing the cancer cells directly and by helping the immune system attack them. […] T-cell engagers (TCEs) can be an option to treat multiple myeloma, typically after other types of drugs have been tried. […] Chemotherapy (chemo) is the use of certain kinds of drugs that destroy or control the growth of cancer cells. These drugs can be taken by mouth or given in a vein or a muscle.
#29 Multiple Myeloma: Improved Prognosis With the Latest Treatments | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/multiple-myeloma-improved-prognosis-latest-treatments
Since 2010, we have seen the emergence of multiple myeloma drugs called monoclonal antibodies. […] The most significant monoclonal antibody has been daratumumab (Darzalex). […] In October 2022, the FDA approved the BCMA-directed bispecific antibody teclistamab (Tecvayli), for people with multiple myeloma in whom previous therapies have not worked. […] In August 2023, the FDA granted accelerated approval to a second BCMA-directed bispecific antibody called elranatamab (Elrexfio) for people with multiple myeloma in whom previous therapies had not worked. […] In August 2023, the FDA also granted accelerated approval to a GPRC5D-directed bispecific antibody called talquetamab-tgvs (Talvey) in people with resistant forms of multiple myeloma. […] A big focus for us will be what we can do for high-risk patients those with aggressive disease that relapses very fast.
#30 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Monoclonal antibodies were designed in a lab to recognize and lock onto certain protein markers on the surface of some cancer cells. […] Daratumumab (Darzalex) is a monoclonal antibody used to treat active multiple myeloma. […] Isatuximab (Sarclisa) is a monoclonal antibody that may be used to treat relapsed or refractory multiple myeloma. […] Talquetamab (Talvey) is a monoclonal antibody that may be used to treat relapsed or refractory multiple myeloma if you have received at least 3 other treatments. […] Selective inhibitors of nuclear export (SINE) are drugs that block exportin 1 (XPO1). […] Selinexor (Xpovio) blocks the XPO1 protein to stop the cell cycle and causes the cancer cell to die. It may be used in combination with bortezomib and dexamethasone to treat relapsed or refractory multiple myeloma.
#31 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Corticosteroids, such as dexamethasone and prednisone, are an important part of the treatment of multiple myeloma. They can be used alone or combined with other drugs as a part of treatment. […] Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells. […] Monoclonal antibodies that target this protein seem to work both by killing the cancer cells directly and by helping the immune system attack them. […] T-cell engagers (TCEs) can be an option to treat multiple myeloma, typically after other types of drugs have been tried. […] Chemotherapy (chemo) is the use of certain kinds of drugs that destroy or control the growth of cancer cells. These drugs can be taken by mouth or given in a vein or a muscle.
#32 Targeted therapy for multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/treatment/targeted-therapy
Monoclonal antibodies were designed in a lab to recognize and lock onto certain protein markers on the surface of some cancer cells. […] Daratumumab (Darzalex) is a monoclonal antibody used to treat active multiple myeloma. […] Isatuximab (Sarclisa) is a monoclonal antibody that may be used to treat relapsed or refractory multiple myeloma. […] Talquetamab (Talvey) is a monoclonal antibody that may be used to treat relapsed or refractory multiple myeloma if you have received at least 3 other treatments. […] Selective inhibitors of nuclear export (SINE) are drugs that block exportin 1 (XPO1). […] Selinexor (Xpovio) blocks the XPO1 protein to stop the cell cycle and causes the cancer cell to die. It may be used in combination with bortezomib and dexamethasone to treat relapsed or refractory multiple myeloma.
#33 Multiple Myeloma: Improved Prognosis With the Latest Treatments | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/multiple-myeloma-improved-prognosis-latest-treatments
Since 2010, we have seen the emergence of multiple myeloma drugs called monoclonal antibodies. […] The most significant monoclonal antibody has been daratumumab (Darzalex). […] In October 2022, the FDA approved the BCMA-directed bispecific antibody teclistamab (Tecvayli), for people with multiple myeloma in whom previous therapies have not worked. […] In August 2023, the FDA granted accelerated approval to a second BCMA-directed bispecific antibody called elranatamab (Elrexfio) for people with multiple myeloma in whom previous therapies had not worked. […] In August 2023, the FDA also granted accelerated approval to a GPRC5D-directed bispecific antibody called talquetamab-tgvs (Talvey) in people with resistant forms of multiple myeloma. […] A big focus for us will be what we can do for high-risk patients those with aggressive disease that relapses very fast.
#34 What are Myeloma Treatment Options? – HealthTree for Multiple Myeloma
https://healthtree.org/myeloma/community/articles/multiple-myeloma-treatment-options
Targeted Inhibitors: these drugs are designed to stop the myeloma cell from being able to replicate and cause cell death. […] Bone Strengtheners: the medications work in different ways with one single purpose: to form new bone in your body and avoid its destruction. It’s intended to maintain your body’s bone cycle or metabolism in harmony. […] Radiation Therapy: this may be used to target specific areas of bone affected by myeloma or to shrink tumors that are causing pain or other symptoms. […] CAR T-Cell therapy: your own T-cells (which are part of your immune system) are engineered so they are able to attack cancerous cells. After this modification, the cells are taken back to your blood by a process called infusion. […] Bispecific Antibody Therapy: these act as a go-between, recognizing and attaching to cancer cells and joining them to the immune systems T cells. That cancer cell-to-T cell attachment results in the T cells attacking cancer cells.
#35 Multiple Myeloma: Improved Prognosis With the Latest Treatments | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/multiple-myeloma-improved-prognosis-latest-treatments
Since 2010, we have seen the emergence of multiple myeloma drugs called monoclonal antibodies. […] The most significant monoclonal antibody has been daratumumab (Darzalex). […] In October 2022, the FDA approved the BCMA-directed bispecific antibody teclistamab (Tecvayli), for people with multiple myeloma in whom previous therapies have not worked. […] In August 2023, the FDA granted accelerated approval to a second BCMA-directed bispecific antibody called elranatamab (Elrexfio) for people with multiple myeloma in whom previous therapies had not worked. […] In August 2023, the FDA also granted accelerated approval to a GPRC5D-directed bispecific antibody called talquetamab-tgvs (Talvey) in people with resistant forms of multiple myeloma. […] A big focus for us will be what we can do for high-risk patients those with aggressive disease that relapses very fast.
#36 Multiple Myeloma: Improved Prognosis With the Latest Treatments | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/multiple-myeloma-improved-prognosis-latest-treatments
Since 2010, we have seen the emergence of multiple myeloma drugs called monoclonal antibodies. […] The most significant monoclonal antibody has been daratumumab (Darzalex). […] In October 2022, the FDA approved the BCMA-directed bispecific antibody teclistamab (Tecvayli), for people with multiple myeloma in whom previous therapies have not worked. […] In August 2023, the FDA granted accelerated approval to a second BCMA-directed bispecific antibody called elranatamab (Elrexfio) for people with multiple myeloma in whom previous therapies had not worked. […] In August 2023, the FDA also granted accelerated approval to a GPRC5D-directed bispecific antibody called talquetamab-tgvs (Talvey) in people with resistant forms of multiple myeloma. […] A big focus for us will be what we can do for high-risk patients those with aggressive disease that relapses very fast.
#37 Multiple Myeloma Treatment & Pharmacologic Management
https://www.cancertherapyadvisor.com/ddi/multiple-myeloma-pharmacologic-treatment/
The drugs approved to date by the FDA for treatment of patients with relapsed or refractory multiple myeloma are summarized in Table 1. […] Approved by the FDA in 2022, teclistamab-cqyv is a bispecific T-cell engager that targets both CD3 on T cells and bispecific B-cell maturation antigen on B cells. […] Another option for patients with relapsed or refractory multiple myeloma who received 4 or more prior lines of therapy is CAR T-cell therapy, which involves a 1-time individualized immune cell therapy infusion. […] Bispecific antibody therapy is more accessible to patients and requires less time than CAR T-cell therapy, which takes weeks for collection, engineering, and manufacturing a patients T cells. […] Chemotherapy is often used for treating patients with multiple myeloma. The route of administration can be either oral or intravenous.
#38 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
Immunomodulatory drugs are an important class of standard treatments used to treat multiple myeloma. […] Monoclonal antibodies are agents that fight disease by activating your immune system. […] Bispecific antibodies are another type of antibody-based immunotherapy. […] Chimeric antigen receptor (CAR) T-cell therapy uses your own white blood cells to fight myeloma. […] Some of the newest drugs used to treat multiple myeloma do not fit the classification of any existing drugs. […] Chemotherapy uses drugs that kill cells that are in the process of dividing. […] Steroids are another important class of multiple myeloma treatment and are used at all stages of the disease. […] Multiple myeloma therapies can cause side effects that differ from person to person. […] There is more to managing multiple myeloma than treating the disease itself.
#39
https://www.nhs.uk/conditions/multiple-myeloma/treatment/
Corticosteroids help destroy myeloma cells and make chemotherapy more effective. […] Thalidomide can help kill myeloma cells. […] Bortezomib (Velcade) can help kill myeloma cells by causing protein to build up inside them. […] Daratumumab helps kill the cancerous myeloma cells. […] People receiving intensive treatment are given a much higher dose of chemotherapy medicine as an inpatient to help destroy a larger number of myeloma cells. […] Further treatment is needed if myeloma returns. Treatment for relapses is similar to initial treatment, although non-intensive treatment is often preferred. […] Lenalidomide and pomalidomide are similar to thalidomide. […] Carfilzomib is a medicine similar to bortezomib. […] Ixazomib citrate (Ninlaro, Takeda) is used to treat multiple myeloma in adults who have had 2 or 3 other therapies.
#40 Patient education: Multiple myeloma treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics
While it does not cure the disease, autologous stem cell transplant can lead to significant and prolonged responses in multiple myeloma. […] „CAR-T” therapy â CAR-T therapy is a form of immunotherapy. It uses the person’s own immune system to target a specific antigen (a type of protein) found on the surface of the cancer cells. […] The initial choice of therapy depends on the person’s health, age, frailty, eligibility for stem cell transplantation, and the aggressiveness of the cancer (whether the disease is considered high risk or standard risk). […] Most people will be treated with a three-drug regimen that includes: An immunomodulatory drug such as lenalidomide (brand name: Revlimid), A corticosteroid such as dexamethasone, and Either a proteasome inhibitor such as bortezomib (brand name: Velcade) or the monoclonal antibody daratumumab (brand name: Darzalex).
#41 Multiple Myeloma: Available Therapies and Causes of Drug Resistance
https://pmc.ncbi.nlm.nih.gov/articles/PMC7072128/
Multiple myeloma (MM) is the second most common blood cancer. Treatments for MM include corticosteroids, alkylating agents, anthracyclines, proteasome inhibitors, immunomodulatory drugs, histone deacetylase inhibitors and monoclonal antibodies. […] Survival outcomes have improved substantially due to the introduction of many of these drugs allied with their rational use. […] Treatment of MM usually includes different combinations of drugs having different mechanisms of action: corticosteroids, alkylating agents, anthracyclines, proteasome inhibitors (PIs), immuno-modulatory drugs (IMIDs), histone deacetylase inhibitors (iHDACs), monoclonal antibodies (mAbs), nuclear export inhibitors and high-dose chemotherapy rescued by autologous stem cell transplantation (ASCT). […] For many years, therapies were based on cytotoxic drugs, mainly melphalan, an alkylating agent, and prednisone, a corticosteroid.
#42 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Treatment with one of these drugs helps prevent further bone damage and events related to weakened bones such as fractures, hypercalcemia (high blood calcium levels), and spinal cord compression in people with multiple myeloma. […] Common side effects of corticosteroids can include: High blood sugar, Increased appetite and weight gain, Problems sleeping, Changes in mood, such as becoming irritable or hyper. […] Common side effects of TCEs include: Fever, Feeling very tired, Headache, Nausea, Diarrhea, Muscle and joint pain, Respiratory infections (including pneumonia), Low blood cell counts, Skin rash, Liver problems. […] Common side effects of selinexor include low platelet counts, low white blood cell counts, diarrhea, nausea, vomiting, not feeling hungry, weight loss, low blood sodium levels, and infections like bronchitis or pneumonia. […] Treatment with one of these drugs is often given for up to 2 years, after which the need for continuing it is reassessed. If the myeloma comes back and new bone problems develop, treatment with a bone-disease drug is usually started again.
#43 Treatment Options for Multiple Myeloma | Blood Cancer Specialists
https://www.oregoncancer.com/multiple-myeloma/treatments
Chemotherapy used to be the primary treatment for multiple myeloma. However, newer drugs have reduced the role of this treatment in some cases. […] Immunotherapy is a revolutionary immunotherapy that helps the bodys immune system detect and attack cancer cells. […] CAR T-cell therapies used to treat multiple myeloma include idecabtagene vicleucel and ciltacabtagene autoleucel. These CAR T-cell therapies target the BCMA protein found in myeloma cells. […] Some corticosteroids or steroids, such as dexamethasone and prednisone, are important in treating multiple myeloma. They can be used alone or in combination with other drugs. […] Immunomodulatory drugs (IMiDs) help treat multiple myeloma by affecting the immune system. […] Thalidomide, lenalidomide, and pomalidomide are immunomodulatory drugs often used to treat multiple myeloma.
#44 Oral Therapies for Multiple Myeloma – touchONCOLOGY
https://touchoncology.com/multiple-myeloma/journal-articles/oral-therapies-for-multiple-myeloma/
A combination of oral cyclophosphamide and steroids (prednisone or dexamethasone) were historically used in patients with advanced MM as an alternative to melphalan-based regimens. […] For myeloma, drugs are given in combinations, either in pairs, doublets or triplets based on risk stratification, genetics, disease stage, transplant eligibility and progression of disease. Many all-oral combinations significantly improve outcomes and survival compared with conventional therapies.
#45 Oral Therapies for Multiple Myeloma – touchONCOLOGY
https://touchoncology.com/multiple-myeloma/journal-articles/oral-therapies-for-multiple-myeloma/
A combination of oral cyclophosphamide and steroids (prednisone or dexamethasone) were historically used in patients with advanced MM as an alternative to melphalan-based regimens. […] For myeloma, drugs are given in combinations, either in pairs, doublets or triplets based on risk stratification, genetics, disease stage, transplant eligibility and progression of disease. Many all-oral combinations significantly improve outcomes and survival compared with conventional therapies.
#46 Multiple Myeloma Treatment & Pharmacologic Management
https://www.cancertherapyadvisor.com/ddi/multiple-myeloma-pharmacologic-treatment/
When choosing treatment for a patient with multiple myeloma, clinicians should consider the patients risk level, comorbidities such as kidney disease or neuropathy and whether the patient is a candidate for hematopoietic stem cell transplantation (HSCT). […] In patients who are eligible for transplant, autologous HSCT, in which the patients own cells are harvested, is the preferred option after primary induction therapy. […] Patients generally receive induction therapy before undergoing HSCT. The preferred treatment for patients at standard risk who are eligible for transplant consists of the triplet regimen bortezomib, lenalidomide, and dexamethasone. […] Additional alternative treatment options for select patients who are eligible for transplant include the following: Daratumumab/lenalidomide/bortezomib/dexamethasone […] Bortezomib/cyclophosphamide/dexamethasone (for patients with renal insufficiency or those who lack access to the preferred regimen) […] Bortezomib/doxorubicin/dexamethasone […] Carfilzomib/cyclophosphamide/dexamethasone (for patients with renal insufficiency and/or peripheral neuropathy) […] Daratumumab/bortezomib/thalidomide/dexamethasone […] Daratumumab/carfilzomib/lenalidomide/dexamethasone […] Daratumumab/bortezomib/cyclophosphamide/dexamethasone […] Bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide (VTD-PACE; for newly diagnosed patients presenting with high-risk and aggressive extramedullary disease or plasma cell leukemia) […] Isatuximab/bortezomib/lenalidomide/dexamethasone.
#47 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Corticosteroids, such as dexamethasone and prednisone, are an important part of the treatment of multiple myeloma. They can be used alone or combined with other drugs as a part of treatment. […] Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells. […] Monoclonal antibodies that target this protein seem to work both by killing the cancer cells directly and by helping the immune system attack them. […] T-cell engagers (TCEs) can be an option to treat multiple myeloma, typically after other types of drugs have been tried. […] Chemotherapy (chemo) is the use of certain kinds of drugs that destroy or control the growth of cancer cells. These drugs can be taken by mouth or given in a vein or a muscle.
#48 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
Immunomodulatory drugs are an important class of standard treatments used to treat multiple myeloma. […] Monoclonal antibodies are agents that fight disease by activating your immune system. […] Bispecific antibodies are another type of antibody-based immunotherapy. […] Chimeric antigen receptor (CAR) T-cell therapy uses your own white blood cells to fight myeloma. […] Some of the newest drugs used to treat multiple myeloma do not fit the classification of any existing drugs. […] Chemotherapy uses drugs that kill cells that are in the process of dividing. […] Steroids are another important class of multiple myeloma treatment and are used at all stages of the disease. […] Multiple myeloma therapies can cause side effects that differ from person to person. […] There is more to managing multiple myeloma than treating the disease itself.
#49 Advances in multiple myeloma treatment – Mayo Clinic Comprehensive Cancer Center Blog
https://cancerblog.mayoclinic.org/2024/05/16/advances-in-multiple-myeloma-treatment/
Multiple myeloma is a blood cancer that most often occurs in people over age 45. […] Right now, there is no cure for the disease. But as Dr. Joselle Cook, a Mayo Clinic hematologist, explains, recent advances in treatment are helping people live longer. […] „The treatment involves we call it plasma cell directed therapy,” says Dr. Cook. „It’s treatments that are specifically directed at the immune system. So it’s usually a combination of three or four drugs.” […] Other advances in treatment include bone marrow transplant, in which a person’s own stem cells are infused after high-dose chemotherapy to rebuild and regenerate healthy bone marrow. […] „We’ve seen new therapies like CAR-T, or chimeric antigen receptor-T cell therapy, where we’re taking people’s T cells, we’re engineering them to specifically recognize a myeloma cell,” says Dr. Cook.
#50 Whatâs New and on the Horizon for Treating Multiple Myeloma?
https://consultqd.clevelandclinic.org/whats-new-and-on-the-horizon-for-treating-multiple-myeloma
Years ago, clinicians had few options beyond melphalan and steroids to treat multiple myeloma. Today, that situation has changed substantially, with new therapy approvals coming fast and furious. […] The four-drug regimen of daratumumab, bortezomib, lenalidomide and dexamethasone in the frontline setting is greatly reducing the chance of early relapse. And with advances in CAR T-cell and bispecific therapies, patients are living longer and having improved quality of life. […] CAR T-cell treatment is one of the best therapies that science has produced. […] To date, there are two CAR T-cell therapies FDA approved for treating multiple myeloma: Idecabtagene vicleucel (ide-cel) reprograms the patients own T-cells to identify and destroy B-cell maturation antigen (BCMA) receptors on the surface of myeloma cells.
#51 Whatâs New and on the Horizon for Treating Multiple Myeloma?
https://consultqd.clevelandclinic.org/whats-new-and-on-the-horizon-for-treating-multiple-myeloma
Ciltacabtagene autoleucel (cilta-cel) is a BCMA-directed, genetically modified, autologous T-cell immunotherapy, which involves reprogramming a patients own T cells with a transgene encoding CAR that directs the CAR positive T cells to eliminate cells that express BCMA. […] Although there is no head-to-head comparison between the two types of CAR T-cell products, real-world analysis recently published in the Journal of Clinical Oncology showed superior efficacy and survival of cilta-cel, with higher incidence of certain toxicities compared with ide-cel. […] The good news about CAR T-cell therapy is that it’s a one-time treatment, so there’s a definitive period of time the patient needs to be away from home. […] Patients usually receive CAR T-cell therapy in the hospital so they can be monitored for side effects, such as cytokine release syndrome.
#52 Whatâs New and on the Horizon for Treating Multiple Myeloma?
https://consultqd.clevelandclinic.org/whats-new-and-on-the-horizon-for-treating-multiple-myeloma
Ciltacabtagene autoleucel (cilta-cel) is a BCMA-directed, genetically modified, autologous T-cell immunotherapy, which involves reprogramming a patients own T cells with a transgene encoding CAR that directs the CAR positive T cells to eliminate cells that express BCMA. […] Although there is no head-to-head comparison between the two types of CAR T-cell products, real-world analysis recently published in the Journal of Clinical Oncology showed superior efficacy and survival of cilta-cel, with higher incidence of certain toxicities compared with ide-cel. […] The good news about CAR T-cell therapy is that it’s a one-time treatment, so there’s a definitive period of time the patient needs to be away from home. […] Patients usually receive CAR T-cell therapy in the hospital so they can be monitored for side effects, such as cytokine release syndrome.
#53 Whatâs New and on the Horizon for Treating Multiple Myeloma?
https://consultqd.clevelandclinic.org/whats-new-and-on-the-horizon-for-treating-multiple-myeloma
The neurotoxicity profile resolves with time, but there are very rare circumstances with the cilta-cel product where some of those toxicities could cause weakness or other long-term changes neurologically. […] Time-to-treatment remains a challenge, however. Currently, it takes between six to eight weeks for CAR T-cell products to be manufactured and administered. […] BiTE therapy works along a similar concept to CAR T-cell therapy. It stimulates and enriches the patients own T-cells and directs them toward destroying myeloma cells. […] There are two FDA-approved BCMA BiTE therapies, teclistamab and elrenatumab, both of which are highly effective in the management of RRMM. […] BiTE therapies are administered subcutaneously during a ramp up period where dosing is titrated. […] After the titrate and monitoring period is over, BiTE therapy is given on an outpatient basis.
#54 Multiple Myeloma: Treatment Options
https://www.cancercenter.com/cancer-types/multiple-myeloma/treatments
Immunotherapy turns your immune system against cancer. […] Though rare for multiple myeloma, surgery may be recommended to remove single tumors called plasmacytomas or tumors causing symptoms. […] In most cases, multiple myeloma patients are prescribed a combination of treatments that work together for better end results and fewer side effects than any single treatment. […] CAR T-cell therapy is a cancer treatment that falls under immunotherapy. […] The potential side effects of this treatment may be severe and include: Cytokine release syndrome (CRS), Problems with the nervous system, Infections. […] Clinical trials provide an opportunity for cancer patients to gain access to novel cancer treatments that may prove to be more beneficial than standard treatments.
#55 Cilta-cel: A new era in multiple myeloma treatment
https://www.drugtargetreview.com/article/155770/cilta-cel-a-new-era-in-multiple-myeloma-treatment/
New cell therapy, Cilta-cel, shows promise in the treatment of multiple myeloma, providing a personalised approach with the potential for long-term remission. […] Recent breakthroughs in treatment are offering renewed hope for multiple myeloma patients, particularly those with relapsed or refractory forms of the disease. […] With cilta-cel, we use the patients own T-cells, modify them to enhance their cancer-fighting abilities, and reinfuse them into the body as a one-off infusion. […] This is where cilta-cel, an advanced cell therapy, plays a crucial role. Cilta-cel is a chimeric antigen receptor (CAR) T-cell therapy designed to specifically target B-cell maturation antigen (BCMA) on the surface of malignant plasma cells, making it particularly effective in treating B-cell malignancies like multiple myeloma.
#56 Cilta-cel: A new era in multiple myeloma treatment
https://www.drugtargetreview.com/article/155770/cilta-cel-a-new-era-in-multiple-myeloma-treatment/
A key breakthrough with cilta-cel is its ability to induce MRD (Minimal Residual Disease) negativity. […] For patients with relapsed multiple myeloma, these results could be transformative. […] In addition to the promising initial results, long-term data from cilta-cel has demonstrated significant benefits. […] One of the key innovations of cilta-cel lies in its personalised treatment approach. […] For elderly patients who are not candidates for aggressive or ongoing treatments, cilta-cel can offer the possibility of living without disease activity for extended periods. […] We are also studying cilta-cel in earlier lines of therapy, not just for relapsed patients, but for newly diagnosed multiple myeloma patients. […] Therapies like cilta-cel offer a promising future for multiple myeloma treatment.
#57 Cilta-cel: A new era in multiple myeloma treatment
https://www.drugtargetreview.com/article/155770/cilta-cel-a-new-era-in-multiple-myeloma-treatment/
A key breakthrough with cilta-cel is its ability to induce MRD (Minimal Residual Disease) negativity. […] For patients with relapsed multiple myeloma, these results could be transformative. […] In addition to the promising initial results, long-term data from cilta-cel has demonstrated significant benefits. […] One of the key innovations of cilta-cel lies in its personalised treatment approach. […] For elderly patients who are not candidates for aggressive or ongoing treatments, cilta-cel can offer the possibility of living without disease activity for extended periods. […] We are also studying cilta-cel in earlier lines of therapy, not just for relapsed patients, but for newly diagnosed multiple myeloma patients. […] Therapies like cilta-cel offer a promising future for multiple myeloma treatment.
#58 Cilta-cel: A new era in multiple myeloma treatment
https://www.drugtargetreview.com/article/155770/cilta-cel-a-new-era-in-multiple-myeloma-treatment/
A key breakthrough with cilta-cel is its ability to induce MRD (Minimal Residual Disease) negativity. […] For patients with relapsed multiple myeloma, these results could be transformative. […] In addition to the promising initial results, long-term data from cilta-cel has demonstrated significant benefits. […] One of the key innovations of cilta-cel lies in its personalised treatment approach. […] For elderly patients who are not candidates for aggressive or ongoing treatments, cilta-cel can offer the possibility of living without disease activity for extended periods. […] We are also studying cilta-cel in earlier lines of therapy, not just for relapsed patients, but for newly diagnosed multiple myeloma patients. […] Therapies like cilta-cel offer a promising future for multiple myeloma treatment.
#59 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
Radiation therapy, which uses high-energy particles or rays to damage cancer cells and prevent them from growing, has proven effective in treating complications from bone disease caused by myeloma. […] In addition to receiving medical treatments directed at managing your disease, you will most likely require additional treatments to help manage symptoms and treatment side effects. […] Drug therapies can help relieve multiple myeloma symptoms, such as bone disease or kidney failure and side effects from treatments such as blood clots.
#60 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
The advantage of this approach over autologous transplantation is that the patient is not at risk of being reinfused with MM cells. […] The use of allogeneic transplantation in MM patients remains largely investigational, for several reasons. […] MM is extremely sensitive to radiation. […] Physicians use radiation to treat symptomatic lesions, to stabilize bones at risk for fracture, and to treat spinal cord compression. […] Agents used for prevention and treatment of skeletal-related events (SREs) in patients with MM include the bisphosphonates zoledronic acid and pamidronate, and the monoclonal antibody denosumab. […] Bisphosphonates are specific inhibitors of osteoclastic activity and are used to treat bone resorption. […] They also have a role in the secondary prevention of bony complications in MM, including hypercalcemia, pathologic fracture, and spinal cord compression.
#61 6 Innovative Multiple Myeloma Treatment Options | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/multiple-myeloma/multiple-myeloma-treatment.html
Immunotherapy is one of several innovative targeted therapies performed by MDAnderson. It uses your own immune cells to fight off cancer cells. […] Radiation therapy often plays a valuable role in providing quick pain relief and decreasing the risk of fractured bones. […] A stem cell transplant (or bone marrow transplant) replaces defective or damaged bone marrow cells with your own healthy blood-forming cells. […] High levels of abnormal proteins can lead to thickening of the blood. […] Autologous stem cell transplants are an option for patients whose cancer is in remission or has stabilized. This type of transplant is used most frequently to treat multiple myeloma and lymphoma. […] A successful autologous stem cell transplant helps many people with lymphoma or multiple myeloma become cancer-free or delays the cancers return. […] Most patients need only a single autologous transplant. Others, particularly those with multiple myeloma, may receive a planned second transplant several months after the first one. This is called a tandem transplant.
#62 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
If your multiple myeloma is resistant to therapy (refractory) or if your myeloma returns after an initial response to treatment (relapsed), you are said to have relapsed or refractory multiple myeloma. […] There are many effective treatment options for relapsed myeloma and more are being tested in clinical studies so if your myeloma relapses, you should not lose hope or think that there are no chances for an effective treatment. […] The main therapies for multiple myeloma involve the use of novel drugs called proteasome inhibitors, immunomodulatory drugs, antibodies, and B-cell maturation antigen (BCMA) targeted therapies, as well as the use of traditional drugs like steroids and chemotherapy. […] Proteasome inhibitors are an important class of multiple myeloma treatments and are used at all stages of disease.
#63 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
If your multiple myeloma is resistant to therapy (refractory) or if your myeloma returns after an initial response to treatment (relapsed), you are said to have relapsed or refractory multiple myeloma. […] There are many effective treatment options for relapsed myeloma and more are being tested in clinical studies so if your myeloma relapses, you should not lose hope or think that there are no chances for an effective treatment. […] The main therapies for multiple myeloma involve the use of novel drugs called proteasome inhibitors, immunomodulatory drugs, antibodies, and B-cell maturation antigen (BCMA) targeted therapies, as well as the use of traditional drugs like steroids and chemotherapy. […] Proteasome inhibitors are an important class of multiple myeloma treatments and are used at all stages of disease.
#64 Patient education: Multiple myeloma treatment (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics
Autologous stem cell transplantation refers to transplantation with the person’s own stem cells. […] Compared with chemotherapy alone, autologous stem cell transplantation is more likely to produce a significant and prolonged response. […] The main treatments used for relapsed or refractory multiple myeloma are: Immunomodulatory drugs (lenalidomide, pomalidomide, thalidomide), Proteasome inhibitors (bortezomib, carfilzomib, ixazomib), Steroids (dexamethasone), Antibodies that target myeloma cells (daratumumab, elotuzumab, isatuximab), Bispecific antibodies (teclistamab, elranatamab, talquetamab), Nuclear export inhibitor (selinexor), Cytotoxic chemotherapy drugs (melphalan, cyclophosphamide), Chimeric antigen receptor (CAR) T cells, Autologous stem cell transplantation.
#65 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
A meta-analysis shows the benefit of maintenance lenalidomide, with a 51% reduction in the risk of recurrence. […] A number of trials have also evaluated bortezomib in maintenance therapy. […] Although trials have shown the benefit of maintenance therapy after ASCT, the risk of second primary malignancies and the need for continuous treatment should be kept in mind. […] Patients who have a relapse after initial disease control may be treated with any of the agents not already utilized. […] If the relapse occurs longer than 6 months after the initial therapy, then the initial regimen can be used again. […] Bortezomib has a well-established role as salvage therapy. […] In 2012, the FDA approved carfilzomib (Kyprolis) for the treatment of patients with MM who have received at least two prior therapies including bortezomib and an immunomodulatory agent.
#66 Multiple Myeloma Treatments | Drugs & Treatment by Stage
https://themmrf.org/diagnosis-and-treatment/treatment-options/
Radiation therapy, which uses high-energy particles or rays to damage cancer cells and prevent them from growing, has proven effective in treating complications from bone disease caused by myeloma. […] In addition to receiving medical treatments directed at managing your disease, you will most likely require additional treatments to help manage symptoms and treatment side effects. […] Drug therapies can help relieve multiple myeloma symptoms, such as bone disease or kidney failure and side effects from treatments such as blood clots.
#67 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0315/p373.html
The optimal treatment for multiple myeloma is two- or three-drug myeloablative chemotherapy, followed by autologous stem cell transplantation (ASCT). […] Patients who are candidates for ASCT are typically treated with induction chemotherapy, followed by transplantation. After ASCT, short-term consolidation therapy is used, followed by maintenance therapy designed to prolong the response at minimal toxicity. […] Select patients with SMM who are at increased risk of progression should be considered for treatment. […] Impairment of renal function is common in patients with multiple myeloma and can occur for a number of reasons, including free light chain damage to the proximal tubules, hypercalcemia, hyperuricemia, volume depletion, infections, and adverse effects of nephrotoxic drugs. […] Bone disease develops in 80% to 90% of patients with myeloma and includes bone pain, pathologic fractures (40%), spinal cord compression (5%), and hypercalcemia.
#68 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
The advantage of this approach over autologous transplantation is that the patient is not at risk of being reinfused with MM cells. […] The use of allogeneic transplantation in MM patients remains largely investigational, for several reasons. […] MM is extremely sensitive to radiation. […] Physicians use radiation to treat symptomatic lesions, to stabilize bones at risk for fracture, and to treat spinal cord compression. […] Agents used for prevention and treatment of skeletal-related events (SREs) in patients with MM include the bisphosphonates zoledronic acid and pamidronate, and the monoclonal antibody denosumab. […] Bisphosphonates are specific inhibitors of osteoclastic activity and are used to treat bone resorption. […] They also have a role in the secondary prevention of bony complications in MM, including hypercalcemia, pathologic fracture, and spinal cord compression.
#69 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
In a phase 3 trial that compared denosumab with zoledronic acid in patients with bone metastases, denosumab was noninferior for delaying SREs and was associated with a significantly lower risk of kidney toxicity. […] In 2021, the International Myeloma Working Group (IMWG) released updated practice guidelines for the management of MM-related bone disease. […] The recommendations include the following: Zoledronic acid is the preferred bone-targeted agent for patients with newly diagnosed MM, whether or not they have MM-related bone disease. […] In 2017, the American Society of Clinical Oncology (ASCO) issued an update to its clinical practice guideline on the role of bone-modifying agents in MM. […] ASCO recommendations include the following: For patients with MM in whom imaging studies show lytic destruction of bone or compression fracture of the spine from osteopenia, intravenous (IV) pamidronate or zoledronic acid is recommended.
#70 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
The advantage of this approach over autologous transplantation is that the patient is not at risk of being reinfused with MM cells. […] The use of allogeneic transplantation in MM patients remains largely investigational, for several reasons. […] MM is extremely sensitive to radiation. […] Physicians use radiation to treat symptomatic lesions, to stabilize bones at risk for fracture, and to treat spinal cord compression. […] Agents used for prevention and treatment of skeletal-related events (SREs) in patients with MM include the bisphosphonates zoledronic acid and pamidronate, and the monoclonal antibody denosumab. […] Bisphosphonates are specific inhibitors of osteoclastic activity and are used to treat bone resorption. […] They also have a role in the secondary prevention of bony complications in MM, including hypercalcemia, pathologic fracture, and spinal cord compression.
#71 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
Osteonecrosis of the jaw is a rare but severe adverse effect of bisphosphonate therapy. […] Surgical therapy for MM is limited to adjunctive treatment. […] It consists of prophylactic fixation of pending fractures, decompression of the spinal cord when indicated, and treatment of pathologic fractures. […] Patients with MM who are receiving bisphosphonate therapy should include adequate calcium in their diet. […] The dietary supplement curcumin, which has anti-inflammatory properties, may slow the progression of smoldering multiple myeloma. […] Patients with MM should be encouraged to be physically active to the extent appropriate for their individual bone status. […] Patients with MM often benefit from the expertise of an orthopedic surgeon who is versed in oncologic management because prophylactic fixation of impending pathologic fractures is occasionally warranted.
#72 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0315/p373.html
Without prophylaxis, thromboembolic events are extremely common in patients with multiple myeloma, especially those receiving immunomodulatory drugs. […] Patients with multiple myeloma are at high risk of serious infections; prompt recognition and treatment are critical. Prophylactic antibiotics are recommended in certain situations; this includes use of trimethoprim/sulfamethoxazole or a fluoroquinolone for the first three months of treatment. […] Patients with multiple myeloma often develop anemia. Evidence supports a restrictive transfusion policy (i.e., transfusion for hemoglobin levels less than 7 g per dL [70 g per L] in most patients); erythropoiesis-stimulating agents decrease the need for red blood cell transfusions, but increase the risk of thromboembolic complications and death.
#73 Drug Therapy for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html
Medicines are the main type of treatment for nearly everyone with multiple myeloma. This treatment could be a single drug or (more likely) several drugs used together. […] The drugs your cancer care team uses to treat your multiple myeloma will depend on many factors. […] A single drug might sometimes be used to treat multiple myeloma. But most often, 2 to 4 different kinds of drugs are combined because this tends to work better. The choice of which drugs to use depends on many factors, including: […] Immunomodulatory drugs (IMiDs) affect the immune system, although exactly how they do this isn’t entirely clear. These drugs are often helpful in treating multiple myeloma. […] IMiDs are taken daily as pills, with breaks from treatment on certain days each month. Because these drugs can increase the risk of serious blood clots, they are often given along with aspirin or a blood thinner.
#74 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
Patients with MM may require hospitalization for the treatment of pain or bony pathology. […] Patients with MM are at high risk of infection, especially from encapsulated organisms. […] The following laboratory results are helpful in the follow-up care of patients with MM: Complete blood count (CBC), serum chemistry profile, serum calcium, and serum uric acid, and serum protein electrophoresis (SPEP) findings.
#75 Multiple myeloma – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
Treatment might include treating complications of multiple myeloma. […] Pain medications, radiation therapy and surgery may help control bone pain. […] People with severe kidney damage may need dialysis. […] Vaccines can help prevent infections, such as the flu and pneumonia. […] Medicines can increase the number of red blood cells in the blood. This can help relieve ongoing anemia.
#76 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0315/p373.html
Without prophylaxis, thromboembolic events are extremely common in patients with multiple myeloma, especially those receiving immunomodulatory drugs. […] Patients with multiple myeloma are at high risk of serious infections; prompt recognition and treatment are critical. Prophylactic antibiotics are recommended in certain situations; this includes use of trimethoprim/sulfamethoxazole or a fluoroquinolone for the first three months of treatment. […] Patients with multiple myeloma often develop anemia. Evidence supports a restrictive transfusion policy (i.e., transfusion for hemoglobin levels less than 7 g per dL [70 g per L] in most patients); erythropoiesis-stimulating agents decrease the need for red blood cell transfusions, but increase the risk of thromboembolic complications and death.
#77 Multiple myeloma – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
Treatment might include treating complications of multiple myeloma. […] Pain medications, radiation therapy and surgery may help control bone pain. […] People with severe kidney damage may need dialysis. […] Vaccines can help prevent infections, such as the flu and pneumonia. […] Medicines can increase the number of red blood cells in the blood. This can help relieve ongoing anemia.
#78 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0315/p373.html
Without prophylaxis, thromboembolic events are extremely common in patients with multiple myeloma, especially those receiving immunomodulatory drugs. […] Patients with multiple myeloma are at high risk of serious infections; prompt recognition and treatment are critical. Prophylactic antibiotics are recommended in certain situations; this includes use of trimethoprim/sulfamethoxazole or a fluoroquinolone for the first three months of treatment. […] Patients with multiple myeloma often develop anemia. Evidence supports a restrictive transfusion policy (i.e., transfusion for hemoglobin levels less than 7 g per dL [70 g per L] in most patients); erythropoiesis-stimulating agents decrease the need for red blood cell transfusions, but increase the risk of thromboembolic complications and death.
#79 Whatâs New and on the Horizon for Treating Multiple Myeloma?
https://consultqd.clevelandclinic.org/whats-new-and-on-the-horizon-for-treating-multiple-myeloma
Researchers are well under way in developing a host of additional multiple myeloma treatments, including: Allogenic CAR T-cell products, which could be available off the shelf, eliminating the time-consuming manufacturing time of autologous CAR T-cell products. […] „BCMA CAR T-cell therapies and BiTE therapies have shown dramatic improvements in multiple myeloma outcomes,” says Dr. Raza. […] Many patients who are not transplant eligible can receive CAR T-cell therapy. […] Consider clinical trials earlier in the patients cancer journey. Referring patients to an academic center can give them access to advanced treatments that are not yet commercially available.
#80 Multiple Myeloma Treatment & Pharmacologic Management
https://www.cancertherapyadvisor.com/ddi/multiple-myeloma-pharmacologic-treatment/
Multiple myeloma treatment options include multiple drug types, including the following: Proteasome inhibitors (bortezomib, carfilzomib, and ixazomib) […] Immunomodulators (IMiDs; eg, lenalidomide, pomalidomide, and thalidomide) […] Monoclonal antibodies (daratumumab, daratumumab/hyaluronidase-fihj, elotuzumab, and isatuximab-ifrc) […] Bispecific antibodies (elranatamab-bcmm, talquetamab, and teclistamab-cqyv) […] Chimeric antigen receptor (CAR) T-cell therapies (ciltacabtagene autoleucel, also called cilta-cel, and idecabtagene vicleucel, also called ide-cel) […] Antibody-drug conjugates (belantamab mafodotin-blmf) […] Nuclear export inhibitor (selinexor) […] Alkylating agents (cyclophosphamide and melphalan) […] Corticosteroids (dexamethasone, methylprednisolone, and prednisone) […] Bone-modifying agents (denosumab, pamidronate, and zoledronic acid) […] Cereblon E3 ligase modulatory drugs (CELMoDs; eg, iberdomide and megzidomide used in clinical trials).
#81 How We Treat Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/treatment
We created the center to understand, at the molecular level, why some patients go on to develop disease, while others do not and to develop non-toxic targeted therapies to prevent progression, or even eliminate the disease before it leads to symptoms. […] Our Center offers access to a wide range of clinical research trials that aim to extend the duration of patients’ responses to treatment, and to improve patient outcomes. […] Many new targeted therapies and immunotherapies are improving treatment outcomes for patients with multiple myeloma.
#82 Multiple Myeloma Treatment | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/multiple-myeloma/multiple-myeloma-treatment
The treatments for active multiple myeloma are: Chemotherapy, Immune-modifying drugs or other medications, Stem cell transplants. […] Your treatment depends on your stage of myeloma and other information. Often, you will have a combination of a few different drugs. […] Several multiple myeloma treatments use drugs, including: Proteasome inhibitors, Immune-modulating drugs, Chemotherapy, Immunotherapy, Monoclonal antibodies. […] MSK also is researching new therapies, including: Bispecific antibodies that bind to 2 different antigens at the same time, Treatments that target specific genetic changes (mutations and variants). […] A stem cell transplant is when we replace your stem cells by infusing (putting in) new, healthy cells into your bloodstream. This procedure also is called a bone marrow transplant.
#83 Multiple Myeloma Treatment & Management: Approach Considerations, Smoldering Multiple Myeloma, Chemotherapy and Immunotherapy
https://emedicine.medscape.com/article/204369-treatment
For a summary of treatment approaches to MM, see Multiple Myeloma Treatment Protocols. […] Patients with high-risk smoldering MM may be considered for lenalidomide treatment. […] In a phase III trial of patients with high-risk SMM, the PETHEMA group found evidence of benefit from treatment with lenalidomide versus observation. […] After a median follow-up of 40 months, study patients who were randomized to lenalidomide and dexamethasone induction followed by lenalidomide maintenance demonstrated significantly prolonged median time to progression (median not reached vs 21 months) and higher 3-year survival rate (94% vs. 80%). […] Lenalidomide as single-agent therapy (without dexamethasone induction) may also slow progression of SMM to MM. […] A phase III trial in 182 patients found that after 3 years, SMM had not progressed to MM in 91% of patients receiving lenalidomide, compared with 66% of those who underwent observation only.