calls for target identification and drug discovery, including protein degradation, IMIDs, PPMs, Ubiquitin ligase, small molecules, and epigenetics modifiers. Combinations of these novel agents already allow us to reach much better and deeper response than conventional chemotherapy. Unfortunately, even after response to treatment, residual cancer cells or myeloma cells not visible by conventional measurements can remain. This is referred to as minimal residual disease. Recent technologies with sequencing allows us to identify one cell in 100,000 and will help us develop better strategies to increase the depth of response. This is happening in many cancers and will in myeloma as well, as patients who achieved a molecular remission have a much better outcome.
presents significant challenges. The multiple myeloma microenvironment offers an extraordinary degree of sanctuary to neoplastic plasma cells. Interaction of myeloma cells with numerous elements of the marrow niche all lead to chemoresistance in multiple myeloma. The primary question, therefore, is how do myeloma cells condition the microenvironment and how does the microenvironment offer protection to those cells.
holds the key to a long-term cure for multiple myeloma by restoring the immune system’s natural ability to eliminate cancer cells. Cancer cells, including myeloma cells, shut down the immune response during their development. This induces a state of tolerance from the immune system which allows cancer cells to escape and continue to grow. Thanks to progress in understanding the biology of the immune response, new tools have been developed, particularly antibodies that unleash the immune system and have shown very impressive anti-tumor activity across multiple cancers including in myeloma.