The treatment of multiple myeloma in an era of precision medicine

ABSTRACT

Introduction: Progress in molecular characterization methods has led to major advances in the field of hematology and oncology, bringing forth new diagnostic tools and therapeutic options. Increased biological knowledge has led to the introduction of new therapeutic options in multiple myeloma (MM), resulting in improved progression-free and overall survival. However, MM still remains an incurable disease and treatment choice is still largely empirical, in an era gradually evolving towards a personalized, patient-tailored approach.

Areas covered: This review discusses the present status of precision medicine in multiple myeloma. The current clinical, cytogenetic and molecular risk classifications are discussed, including the emerging concept of frailty and minimal residual disease in clinical decision-making. Finally, we discuss promising molecular targets and candidate biomarkers for drug sensitivity.

Expert opinion: At present, precision medicine in MM is primarily based on patient-related factors, especially in the elderly patient population. Many bridges still need to be built between basic science and clinical medicine to truly capture the notion of molecular precision medicine. However, as novel therapeutic modalities are rapidly emerging, and knowledge on the molecular profile of MM is continuously increasing, true targeted therapy might become reality for myeloma patients in the near future.

KEYWORDS:

• Multiple myeloma
• precision medicine
• risk stratification
• frailty
• residual disease
• biomarkers

Article highlights

• The concept of precision medicine is gradually finding its way into the clinical practice of multiple myeloma, although it is still primarily based on clinical factors, especially in the elderly patient population.

• The revised International Staging System is still the most commonly applied risk classification score in newly diagnosed multiple myeloma.

• In the elderly patient population, treatment intensity is increasingly guided by underlying frailty. {Usmani:2016dy}

• The concept of minimal residual disease (MRD) is gradually finding its way into clinical practice, as MRD-negative status strongly correlates with progression-free and overall survival.

• The therapeutic landscape of multiple myeloma is rapidly evolving, with several forms of immune therapy showing excellent preliminary results.

Declaration of interest

M Delforge has received research funding from Celgene and Janssen and consultancy fees from Amgen, Celgene, Janssen and Takeda. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by UZ/KU Leuven