Abstract
Treatment options for multiple myeloma (MM) have evolved significantly over the past four decades, improving overall survival (OS) through a deeper understanding of tumor biology and personalized treatment strategies. Key factors for individualizing therapy include eligibility for autologous stem cell transplantation (ASCT), disease risk stratification, patient frailty, performance status, age, and comorbidities, aiming to maximize disease control while minimizing toxicity. Current evidence supports triplet or quadruplet regimens incorporating an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory drug, and dexamethasone, with or without ASCT, as initial therapy. Recent studies have explored whether specific regimen components can be omitted without compromising efficacy and whether maintenance therapy can be discontinued after sustained minimal residual disease (MRD) negativity for 12 months. This review examines the evolving recommendations and evidence guiding these treatment decisions.
Keywords
Evolution of treatment, Immunotherapy, Initial therapy, Multiple myeloma, Quadruple therapy