Multiple Myeloma: Latest Research

Aprobado por la Junta Editorial de Cancer.Net, 07/2022

ON THIS PAGE: You will read about the scientific research being done to learn more about multiple myeloma and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about myeloma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you. With the fast pace of myeloma research, you are encouraged to ask about available clinical trials.

  • New drugs. Myeloma represents a new treatment paradigm (a set of assumptions and practices) in cancer because the new drugs that target the tumor cell, tumor-bone marrow interaction, and bone marrow environment can overcome normal drug resistance. Drugs are first tested in clinical trials for advanced myeloma and then used to treat earlier-stage myeloma. A variety of new drugs are being studied for the treatment of relapsed myeloma and relapsed, refractory myeloma, including the examples below.

    • B-cell maturation antigen (BCMA). BCMA is a marker on the plasma cells that can be targeted for the treatment of myeloma. As discussed in Types of Treatment, several treatments that target BCMA are now approved to treat myeloma. Antibodies that bring immune cells to destroy myeloma cells are called bispecific antibodies, and they work similarly to the way bispecific T-cell engagers work (see below). Antibody-drug conjugates (ADCs) are antibodies that carry a drug that kills cancer cells when the antibody binds to them. Belantamab mafadotin is the only antibody-drug conjugate approved to treat multiple myeloma at this time. There are also chimeric antigen receptor (CAR) T-cell therapies that target BCMA.

    • Venetoclax (Venclexta, Venclyxto). This BCL-2 inhibitor has been used to treat some types of lymphoma and leukemia, and there may be benefit to using it to treat myeloma with a specific genetic mutation that appears in about 20% of patients with myeloma.

    • Bispecific T-cell engagers. As described in Types of Treatment, bispecific antibodies are monoclonal antibodies that target a protein on the myeloma cell surface and a T cell. Clinical trials are studying this treatment in multiple myeloma, and the first bispecific T-cell engager that targets both BCMA (a myeloma marker) and CD3 (a T-cell marker) was approved to treat multiple myeloma in 2022.

  • Drug combinations. Most myeloma cells will eventually become resistant to standard chemotherapy, a condition called multidrug resistance. Many new drug combinations have been developed and are being studied in various settings, including:

    • Bortezomib and lenalidomide in combination with dexamethasone

    • Bortezomib, cyclophosphamide, and dexamethasone

    • Carfilzomib, lenalidomide, and dexamethasone

    • Ixazomib, lenalidomide, and dexamethasone

    • Pomalidomide, bortezomib, and dexamethasone

    • Carfilzomib, pomalidomide, and dexamethasone

    • Pomalidomide, ixazomib, and dexamethasone

    • Pomalidomide, dexamethasone, and clarithromycin (Biaxin)

    • Daratumumab, bortezomib, and dexamethasone

  • Immunotherapy. This type of therapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. Vaccines are a type of immunotherapy being explored in the treatment of multiple myeloma. Research on using these therapies to treat advanced myeloma is ongoing. Learn more about the basics of immunotherapy.

    • CAR T-cell immunotherapy. In this type of immunotherapy, some T cells are removed from a patient’s blood. Then, the cells are changed so they have specific proteins called receptors. The receptors allow the changed T cells to recognize the cancer cells. The changed T cells are then returned to the patient’s body. Once there, they seek out and destroy cancer cells. Two CAR T-cell therapies, idecabtagene vicleucel and ciltacabtagene autoleucel, have received FDA approval (see Types of Treatment), and more clinical trials are studying other CAR T-cell therapies in myeloma. Researchers are also examining the effectiveness of BCMA-targeted CAR T cells in combination with other treatments, as well as working to identify other antigens found on myeloma cells that may be effective immunotherapy targets. Learn more about the basics of CAR T-cell therapy.

    • Immune checkpoint inhibitors. Checkpoint inhibitor therapies include antibodies to block PD-L1 on multiple myeloma cells and PD-1 on immune cells. PD-1 is found on the surface of T cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, blocking PD-1 allows the immune system to better eliminate the disease. Current research is trying to work out which patients benefit most from these treatments and in which combinations of other drugs they should be used. The FDA stopped all clinical trials using PD-1 checkpoint inhibitors in multiple myeloma. In 1 study of combination therapy that included pembrolizumab (Keytruda), researchers saw an increased death rate. Other checkpoint inhibitors targeting LAG3, TIM3, and TIGIT are being studied.

    • Cancer vaccines. Vaccines are another type of immunotherapy being explored in the treatment of multiple myeloma. Learn more about therapeutic cancer vaccines.

  • Palliative and supportive care. A limited number of clinical trials are underway to find better ways of reducing symptoms and side effects of current myeloma treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in myeloma, explore these related items that will take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.