Updates to the Management of Multiple Myeloma

This is the authors' abstract. We don't add key points for this paper.

Patients with smoldering myeloma should undergo periodic risk assessment—if they are deemed at high risk for disease progression, clinical trials or lenalidomide with or without dexamethasone should be considered. The initial treatment of newly diagnosed myeloma should be based on the patient’s risk, fitness, and preferences. Induction with a quadruplet regimen, followed by autologous transplantation and maintenance therapy, remains the standard of care, especially for those with high-risk disease. For patients with standard-risk disease not undergoing immediate transplantation, triplet or quadruplet induction followed by maintenance is the standard. Appropriate treatment of relapsed disease depends on response to previous treatment, residual side effects, and comorbidities. T-cell–redirecting therapies and other novel agents have shown activity, even in heavily pretreated patients. Most patients will require multiple lines of therapy over the course of the disease.