Usmani Saad Z., Nooka Ajay K. (eds.) Personalized Therapy for Multiple Myeloma

Springer, 2018. — 183 p. — ISBN: 978-3-319-61871-5.The management of multiple myeloma (MM) has evolved tremendously over the last decade, from being an orphan disease with limited treatment options to a disease that can be chronically managed for most patients. The knowledge of the heterogenous disease biology and development of novel drug classes (immunomodulatory drugs, proteasome inhibitors, etc.) that target this disease have resulted in more than doubling the overall survival for MM patients. There is a recognition that MM has several different molecular/clinical phenotypes and that several genomic subclones exist in any given patient — clearly, MM is not a one-pathway disease. Given such variability, a cookie-cutter approach may not be applicable to MM, and many factors influence treatment strategies for a given patient. Several long-standing paradigms are being shifted, and such changes are coming at a rapid pace.
We know that monoclonal gammopathy of undetermined significance (MGUS) gives rise to smoldering and active MM yet had previously been unable to identify the subset that is at the highest risk of progression to active disease. By utilizing clinical variables, flow cytometry, novel imaging techniques, and genomic tools, there are models that can help identify this “high-risk” group. Clinical trials are now evaluating the role of early therapeutic intervention in this group. For newly diagnosed MM, better prognostication models are being developed that include biologic data. Novel agent regimens are starting to look beyond the proteasome inhibitor/immunomodulatory drug induction regimens, incorporating new mechanisms of action and strategies. Autologous stem cell transplants remain an important part of early therapy, but investigations are under way to examine the timing of this modality. Gone are the days when fixed duration (as is the case of solid tumors) was the norm in MM, as maintenance therapy has shown to improve survival outcomes and has become a standard of care. Several three-drug regimens have shown to be more effective than two-drug regimens for both newly diagnosed and relapsed MM patients in large phase III trials, thus laying rest to the debate and confirming what we would have intuitively guessed based on MM biologic heterogeneity. MM is becoming a chronically managed disease where supportive care measures, pain management, and bone health management become an integral part of improving patients’ quality of life. Yet, there remain many research questions that remain unanswered, and the task of curing this cancer is not accomplished.
In this book, we have attempted to provide an assimilation of the most current data in advising the clinicians on the practical management of MM patients written by the foremost authorities in the field.