Current Strategies and Future Directions in Multiple Myeloma: Disease Overview and Pathophysiology, Conventional Treatments and Emerging Therapies, Challenges and Innovations in Management

Abstract

The review examines multiple myeloma, including pathophysiology, conventional treatments, current management strategies, treatment challenges, and emerging therapies. The disease, originating from malignant plasma cells, leads to bone marrow infiltration and osteolytic lesions. Common manifestations include anemia, bone pain, renal dysfunction, and hypercalcemia. Pathophysiological aspects involve disrupted signaling pathways and conflicts between myeloma cells and the bone marrow environment. Conventional treatments, such as chemotherapy with melphalan and cyclophosphamide, corticosteroids (e.g., dexamethasone), and autologous stem cell transplantation (ASCT), have improved patient outcomes but come with significant side effects, including myelosuppression and infection risks. Recent advances in management involve targeted therapies like proteasome inhibitors (e.g., bortezomib) and immunomodulatory drugs (e.g., lenalidomide), as well as monoclonal antibodies (e.g., daratumumab) and innovative immunotherapies, including CAR T-cell therapy and bispecific antibodies. Precision medicine enhances treatment by customizing therapies based on individual genetic and molecular profiles. Despite these advancements, challenges such as drug resistance, relapse, and refractory disease persist. Resistance mechanisms, including the upregulation of anti-apoptotic proteins and mutations affecting drug metabolism, hinder effective treatment. Managing relapsed or refractory cases frequently requires reassessing treatment strategies and exploring novel therapies. Current treatments' adverse effects, both hematological and non-hematological, impact patient quality of life, necessitating strategies, such as supportive care, dose adjustments, and proactive patient education.