30 Years of Improved Survival in Non-Transplant-Eligible Newly Diagnosed Multiple Myeloma

The treatment of multiple myeloma (MM) has greatly evolved these past few years. Recent advances in therapeutics have largely benefited elderly patients now renamed non-transplante-ligible (NTE) patients. Since the 1960s, and for several decades, chemotherapy was the only treatment for MM. Then, the field was marked by the emergence of targeted therapies in the 2000s, such as immunomodulating agents (thalidomide, lenalidomide, and pomalidomide) and proteasome inhibitors (bortezomib, carfilzomib, and ixazomib), which were the first steps towards an increase in survival. Thereafter, the apparition of monoclonal antibodies (mAbs) was considered a milestone in the treatment of MM for both transplant-eligible and NTE patients. Anti-CD38 mAbs can be safely administered to older patients with an impressive efficacy leading to a never-achieved-before survival rate with the triple association of anti-CD38 mAbs, lenalidomide, and dexamethasone. However, progress is still expected with the introduction in the armamentarium for NTE patients of the most recent innovative immunotherapy-based treatments newly introduced in MM, e.g., CAR-T cells and bispecific antibodies. These improved versions of immune-based treatments will probably also benefit NTE patients, although further studies will be needed to better understand their role in this population.

Automated summary

The treatment of multiple myeloma (MM) has drastically improved over the years, especially for elderly patients. Chemotherapy was the main treatment for MM in the past, but targeted therapies such as immunomodulating agents and proteasome inhibitors have led to increased survival rates. The introduction of monoclonal antibodies has been a significant advancement in MM treatment for both transplant-eligible and non-transplant-eligible patients. However, further progress is expected with the use of innovative immunotherapy-based treatments like CAR-T cells and bispecific antibodies.