Multiple myeloma is a hematologic cancer that affects plasma cells, a type of white blood cell found in the bone marrow. These cells, normally involved in the production of antibodies, proliferate uncontrollably in myeloma, thus affecting the production of normal blood cells and weakening bones.

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Differences between myeloma and other blood cancers

Multiple myeloma is often compared to leukemias and lymphomas, but it has distinct characteristics :

• It touches plasma cells in the bone marrow (not white blood cells like leukemia).
• It does not form a single tumor but Spreads into several bones.
• Unlike lymphomas, it does not directly affect the lymph nodes.

The treatment of multiple myeloma depends on several factors: stage of the disease, Age of the patient, general condition and genetic factors. It is based on a combined approach including targeted treatments, chemotherapy, immunotherapy, and sometimes stem cell transplantation.

1. First-line treatment (newly diagnosed patient)

The initial treatment is aimed at reduce tumor burden and control symptoms.

a) Patients eligible for stem cell transplantation

For patients young people (< 70 years old) and healthy.

1. Induction treatment (reduction of the tumor before the transplant)
   • Standard triple therapy :
     • Proteasome inhibitor (ex: bortezomib).
     • Immunomodulatory (ex: lenalidomide or thalidomide).
     • Corticoid (ex: dexamethasone).
2. Autologous stem cell transplant
   
   • After chemotherapy at high doses (melphalan).
   • Enables prolonged remission.
3. Consolidation and maintenance treatment
   
   • Lenalidomide to maintain the response and delay relapses.

b) Patients not eligible for transplantation

For the older patients (> 70 years) or with comorbidities.

• Adapted triple therapy (bortezomib + lenalidomide + dexamethasone) or adapted chemotherapy.
• Maintenance treatment to prolong remission.

2. Treatment of relapses or refractory myeloma

When the disease recurs after initial treatment.

1. New targeted therapies
   
   • Ex: Daratumumab (anti-CD38 monoclonal antibody).
   • E.g.: Carfilzomib (proteasome inhibitor).
   • E.g.: Pomalidomide (immunomodulatory).
2. Catch-up chemotherapies
   
   • Association of new drugs to control relapse.

CAR-T cells and bispecific antibodies (new experimental approaches).

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