[The most recent developments in diagnosis and treatment of multiple myeloma].

Abstract

Recently a great progress in the diagnosis and treatment of multiple myeloma has been made. Substantial revisions in diagnostic criteria were introduced. As a result a neoplasm called very high risk asymptomatic myeloma is currently regarded a disease that needs to be treated. The comprehension of progression mechanism and clonal evolution not only helped to understand the disease course but might contribute to expand treatment options and individualize the therapy. Modern triple therapy containing IMiDs and proteasome inhibitors resulted in the higher response rate than ever before which led to triple therapy incorporation as a frontline treatment. U.S. Food and Drug Administration (FDA) registered for new drugs in 2015 (two monoclonal antibodies and two oral drugs) in relapsed/refractory myeloma. Together with currently existing drugs it considerably expended the therapeutically spectrum. Even drugs that are not effective when used as a monotherapy like panobinostat and elotuzumab play important role in complex therapy, particularly in refractory patients. The most recent trials dedicated to the role of the novel drugs in the induction phase suggest that high–dose therapy followed by autologous stem cell transplantation improve progression free survival and quality of life. Myeloma treatment schedules incorporate more and more innovative immunotherapy methods: adoptive T-cell therapies, vaccines and monoclonal antibodies. Although multiple myeloma is still regarded incurable neoplasm, due to better disease understanding and access to novel drugs, we are getting closer than ever before to evolve therapy that will provide long-lasting effects or at least converting it into the chronic slowly developing disease.