Vnitr Lek 2025, 71(3):176-182 | DOI: 10.36290/vnl.2025.031

New therapeutic options and trends in the treatment of multiple myelom

Roman Hájek^{1, 2}, Ludmila Muroňová^{1, 2}, Jana Mihályová^{1, 2}, Michaela Horňáková¹, Tereza Popková^{1, 2}, Hana Plonková¹, Tomáš Jelínek^{1, 2}

¹ Klinika hematoonkologie FN Ostrava

² Klinika hematoonkologie, Lékařská fakulta Ostravské univerzity

Progress in multiple myeloma (MM) treatment is remarkable. Combined regimens for newly diagnosed MM patients achieve progression-free survival of more than seven years. In the Czech Republic, the approval of a four-drug combination of anti-CD38 monoclonal antibody (mAb) with a proteasome inhibitor (PI), immunomodulatory agent (IMiD) and dexamethasone is expecting in 2025. It is not yet clear whether consolidation with autologous transplantation will be beneficial in terms of extending the time to progression. The development of immunotherapy has literally exploded. Autologous chimeric antigen receptor T-cell therapy (CAR T-cells) targeting the BCMA antigen have already been approved for second-line therapy in the USA. The development of bispecific antibodies (bsAb) is even faster. Bispecific antibodies targeting BCMA and GPRC5D antigens are available in late relapse. Clinical trials are testing additional therapeutic targets (e.g., FcRH5) and combination regimens (e.g., bsAb, PI, IMiD). Response rates to these combinations in the first line treatment are 90-100 %, with a high percentage of patients achieving minimal residual disease (MRD) negativity. In 2024, assessment of MRD was approved as a primary outcome in clinical trials and it is likely that we are now moving to wals an era of MRD-driven therapy.

Keywords: immunotherapy, minimal residual disease, CAR T-cells, bispecific antibodies.

Accepted: April 28, 2025; Published: May 16, 2025  Show citation