Is There Improvement in the Care for Patients With Multiple Myeloma?

Improved understanding of the multiple myeloma biology along with the discovery of novel anti-myeloma agents has led to a better-quality treatment of these patients. Multiple myeloma can cause a variety of complications such as hyperviscosity syndrome, hypercalcaemia, spinal cord compression, early infection, bone disease and renal impairment, some of which are life-treatening. Treatment of these has been demonstrated to significantly reduce morbidity and early fatal outcome. Utilization of novel agents including Thalidomide, Bortezomib and Lenalidomide as part of the induction protocols before autologous stem cell transplantation (ASCT) and also as a front-line treatment in older patients, has been shown to be superior in comparison with the previous treatment strategies. The latter has been confirmed regarding the overall treatment response, progression-free survival and even better overall survival in some studies. Greater experience in dosing of these medications has led to a decrease in the toxicity of the protocols. A third phase clinical study has demonstrated a better clinical outcome when Bortezomib was used prior ASCT. Furthermore, involvement of these agents in the post-transplant consolidation and maintenance treatments has been shown to be beneficial in other aspects such as prolongation of progression-free survival. The immune therapy represents a potentially promising treatment modality. Daratumumab is a new, specific, human monoclonal antibody with high affinity to a unique epitope on CD38. It induces plasma cells death through several immunological mechanisms. It has a good safety profile and a substantially activity as a single-agent therapy in refractory and relapsed myeloma.