REVIEW article

Front. Oncol.

Sec. Cancer Immunity and Immunotherapy

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1578529

Revolutions at the Frontline of Multiple Myeloma Treatment: Lessons and Challenges to Finding a Cure

Provisionally accepted
  • 1University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • 2Case Medical Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
  • 3University of Puerto Rico at Ponce, Ponce, Puerto Rico

The final, formatted version of the article will be published soon.

Multiple myeloma (MM) is a cancer of bone marrow plasma cells. A noteworthy ensemble of therapies has been introduced over the past quarter century that exert antimyeloma activities through diverse mechanisms and achieve durable disease control in many patients. The discovery that proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) target specific plasma cell features that reflect disease biology and exert antimyeloma activity led to transformative changes in treatment algorithms. Recently, advances in immunotherapy have emerged and represent a promising option with the potential to capture immunologic memory and yield more durable responses in MM patients. Idecabtagene vicleucel and ciltacabtagene autoleucel are chimeric antigen receptor (CAR) T-cell immunotherapies that attach to the extracellular domain of the Bcell maturation antigen (BCMA) and have demonstrated significant response rates in heavilytreated patients. These agents are FDA-approved for relapsed and/or refractory (RR)MM patients previously treated with PIs, IMiDs, and CD38-directed monoclonal antibodies. Most patients who receive CAR T-cell therapy relapse after prolonged or brief remission, and a more thorough understanding of the resistance mechanisms following CAR T-cell infusion is needed. Bispecific antibodies (BsAbs) are engineered to simultaneously bind to both cancer and immune cells and trigger a direct tumor-specific cytotoxic response. BsAbs and CAR T-cells are major histocompatibility complex (MHC)-independent approaches to treat MM and do not require T-cell receptor (TCR) specificity. Agents that target BCMA and G protein-coupled receptor class C group 5 member D (GPRC5D) demonstrate impressive clinical responses, while early-phase trials targeting FcRH5 are promising. Here, we provide a comprehensive overview of their individual efficacy, adverse effects, and limitations that impact broader application.

Keywords: Myeloma, Proteasome, Immunotherapy, chemoresistance, CAR T cell, Plasma cell

Received: 17 Feb 2025; Accepted: 22 May 2025.

Copyright: © 2025 Driscoll, Kort, Rivera and Senigarapu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: James Joseph Driscoll, University Hospitals Cleveland Medical Center, Cleveland, 44106, Ohio, United States

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