Immunotherapy in multiple myeloma: when, where, and for who?

PURPOSE OF REVIEW: Immunotherapy is transforming treatment of multiple myeloma patients in all stages of their disease. This review will discuss recent developments in immunotherapy in multiple myeloma with a focus on antibodies, antibody-drug conjugates, and T-cell-redirection strategies.

RECENT FINDINGS: CD38-targeting antibodies have single agent activity in multiple myeloma, and especially when combined with other drugs, are improving the clinical outcome of patients with newly diagnosed or relapsed/refractory multiple myeloma. Also the SLAMF7-targeting antibody, elotuzumab, improves the survival of relapsed/refractory multiple myeloma patients, when it is combined with either lenalidomide or pomalidomide. Several novel immunotherapies, such as chimeric antigen receptor T cells, antibody-drug conjugates, and bispecific antibodies, are active in patients who developed resistance to all currently available antimultiple myeloma drugs, including immunomodulatory drugs, proteasome inhibitors, and CD38 antibodies. These new immunotherapeutic agents frequently target B-cell maturation antigen, which is highly and uniformly expressed on multiple myeloma cells. However, other targets, such as GPRC5D, are also being investigated.

SUMMARY: Immunotherapy is incorporated into first-line and relapse regimens, and is improving the survival of both newly diagnosed and relapsed/refractory multiple myeloma patients.