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Response-Adapted Therapy for Newly Diagnosed Multiple Myeloma

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Abstract

Purpose of Review

The development of potent novel agents has improved outcomes for patients with multiple myeloma (MM). Heterogeneity of response to therapy, an expanding arsenal of treatment options, and cost are however major challenges for physicians making treatment decisions. Response-adapted therapy is hence an attractive strategy for sequencing of therapy in MM. Despite its successful application in other haematologic malignancies, response-adapted therapy is yet to become a standard of care for MM. We provide our perspective on response-adapted therapeutic strategies evaluated thus far and how they may be implemented and improved on in treatment algorithms of the future.

Recent Findings

While older studies suggested that early response based on International Myeloma Working Group response criteria could impact long-term outcomes, recent data have contradicted these findings. The advent of minimal residual disease (MRD) as a powerful prognostic factor in MM has raised the promise of MRD-adapted treatment strategies. The development of more sensitive techniques for paraprotein quantification as well as imaging modalities to detect extramedullary disease is likely to change response assessment in MM. These techniques combined with MRD assessment may provide sensitive and holistic response assessments which could be evaluated in clinical trials.

Summary

Response-adapted treatment algorithms have the potential to allow an individualised treatment strategy, maximising efficacy, while minimising toxicities and cost. Standardisation of MRD methodology, incorporation of imaging into response assessment, and the optimal management of MRD positive patients are key questions to be addressed in future trials.

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Data Availability

Data may be shared upon reasonable request by contacting the corresponding author, Dr Sanjay de Mel, at Sanjay_widanalage@nuhs.edu.sg.

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Authors and Affiliations

  1. Department of Haematology-Oncology, National University Cancer Science Institute of Singapore (NCIS), National University Health System, Singapore, Singapore

    Winnie Z. Y. Teo, Adeline Lin, Fangfang Song, Melissa Ooi, Cinnie Yentia Seokojo, Wee Joo Chng & Sanjay de Mel

  2. Fast and Chronic Program, Alexandra Hospital, National University Health System, Singapore, Singapore

    Winnie Z. Y. Teo

  3. Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore

    Ian Y. E. Ong

  4. Department of General Surgery, National University Health System, Singapore, Singapore

    Jason W. Y. Tong

  5. Department of General Surgery, Singapore General Hospital, Singapore, Singapore

    Wan Li Ong

  6. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Bee Choo Tai

  7. SingHealth Duke-NUS Blood Cancer Centre, Singapore General Hospital, Singapore, Singapore

    Yunxin Chen & Chandramouli Nagarajan

  8. Department of Haematology, Singapore General Hospital, Singapore, Singapore

    Yunxin Chen & Chandramouli Nagarajan

  9. Department of Medicine Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Wee Joo Chng & Sanjay de Mel

  10. Cancer Science Institute, National University of Singapore, Singapore, Singapore

    Wee Joo Chng

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  1. Winnie Z. Y. Teo
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Correspondence to Sanjay de Mel.

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Teo, W.Z.Y., Ong, I.Y.E., Tong, J.W.Y. et al. Response-Adapted Therapy for Newly Diagnosed Multiple Myeloma. Curr Hematol Malig Rep 18, 190–200 (2023). https://doi.org/10.1007/s11899-023-00704-9

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