Multiple Myeloma, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology

Abstract

The treatment of relapsed/refractory multiple myeloma (MM) has evolved to include several new options. These include new combinations with second generation proteasome inhibitors (PI); second generation immunomodulators, monoclonal antibodies, CAR T cells, bispecific antibodies, selinexor, venetoclax, and many others. Most patients with MM undergo several cycles of remissions and relapse, and therefore need multiple lines of combination therapies. Selecting treatment options for relapsed/refractory MM requires consideration of resistance status to specific classes, and patient-specific factors such as age and other comorbidities should be considered. The NCCN Guidelines for MM provide a framework on which to base decisions regarding workup, treatment, and follow-up of newly diagnosed and previously treated MM. This manuscript outlines the recommendations from NCCN Guidelines for MM specific to relapsed/refractory disease.

N6-methyladenosine-modified circ_0000337 sustains bortezomib resistance in multiple myeloma by regulating DNA repair

“…MM specimens were collected from the Third Xiangya Hospital of Central South University. According to the NCCN Clinical Practice Guidelines (Kumar et al, 2023), the patients were divided into bortezomib-resistant (n = 25) and bortezomibsensitive (n = 25). Bortezomib resistance or sensitivity was defined in MM with or without recurrence at the time of bortezomib application.…”

The Role of Autologous Stem Cell Transplantation in the Treatment of Newly Diagnosed Multiple Myeloma: Is It Time to Rethink the Paradigm in the Era of Targeted Therapy?

“…The past four decades have witnessed an explosion of new treatments, such that the modern therapeutic armamentarium is barely recognizable from that of the 1980s. And yet, HDM not only endures but also retains its position as a standardof-care approach, together with autologous stem cell transplantation (ASCT), for eligible patients with newly diagnosed MM (NDMM) [2][3][4][5]. Clearly, melphalan matters in MM.…”

“…Thus, an increasing proportion of transplant-eligible NDMM patients could potentially Additional studies will also inform the optimal duration of maintenance in patients achieving and sustaining MRD-negative status; indeed, it is sustained MRD negativity (two assessments ≥ 1 year apart) rather than simply achieving MRD-negative status that is more highly prognostic for PFS and OS [25,63] and a prerequisite for a functional "cure". Continuous induction/maintenance until disease progression is the standard of care in some geographies [4,5]; however, for those achieving MRD negativity, with or without ASCT, it will be important to understand "how much is enough"-i.e., after what duration of sustained MRD negativity can treatment be stopped without adversely affecting outcome-in order to avoid toxicities from unnecessarily prolonged therapy. Furthermore, the threshold for MRD-negative status in treatment decision making-i.e., 10 −5 or 10 −6 -is an area of ongoing study, with the more sensitive threshold offering greater prognostic value [33,64] and emerging as the gold standard in research and clinical trials.…”

CAR-T Therapy in Multiple Myeloma: Looking Beyond

“…Over the recent 20 years, the treatment of MM has undergone dramatic changes with the introduction of numerous drugs. Treatment regimens, including proteasome inhibitors (PIs), IMiDs, and monoclonal antibodies (mAbs), have led to improved survival and enhanced quality of life in newly diagnosed (NDMM) and relapsed/refractory MM (RRMM) patients [2].…”