Optimizing multiple myeloma treatment: conclusions

Abstract

The search for the optimal treatment strategy in multiple myeloma (MM) is fuelled by improved understanding of the cellular pathology of myeloma. Dr Borrello’s review highlights the importance of the bone marrow microenvironment for MM development and proliferation. In addition to the genetic anomalies and mutations that underlie the development of MM, there is an intricate web of autocrine and paracrine interactions between MM cells and the bone marrow microenvironment that supports disease progression. Unraveling these interactions is yielding valuable targets for future treatments and highlights the importance of maintaining control of the residual disease to delay or prevent disease progression. Long-term disease control may be possible using continuous treatment with novel agents, such as lenalidomide and bortezomib, which are able to control the MM clone and prevent its re-growth by modulating the interactions between MM cells and the bone marrow microenvironment. The second and third articles in this supplement summarize evidence for the use of maintenance therapy in patients with newly diagnosed disease. A large proportion of newly diagnosed MM (NDMM) patients are unsuitable for high-dose therapy (HDT) and autologous stem-cell transplantation (ASCT) either due to their age (aged >65 years) and/or the presence of comorbidities. For such patients, the challenge is to find an agent or therapeutic regimen that is effective and well-tolerated. Dr Niesvizky and I discuss the current clinical evidence supporting the use of the novel agents as maintenance therapy in elderly, transplant-ineligible patients. This treatment approach has led to unprecedented gains in progressionfree survival (PFS), potentially improving quality of life for these patients. However, extended survival is yet to be seen with longer follow-up [1–3]. The suppression of residual disease in young, fit patients with