The future of multiple myeloma care

Inspired by the wealth of new data and insights presented at the 2025 IMS Meeting, Prof Dr Claudio Cerchione, haematologist at the Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori in Meldola (Italy), shares his outlook on the future of myeloma care.

In recent years, we have witnessed a true paradigm shift in the treatment of newly diagnosed multiple myeloma (NDMM). Based on the results of several pivotal clinical trials, such as CEPHEUS, PERSEUS, IMROZ, and GMMG-HD7, the combination of anti-CD38 monoclonal antibodies with classical triplet regimens has become the preferred first-line treatment for both transplant-eligible and transplant-ineligible NDMM patients. With these quadruplet regimens, the goals of myeloma care have evolved from mere disease control towards achieving deep responses and minimal residual disease (MRD) negativity. This progress possibly paves the way for a treatment-free remission in MM. Further improvements in long-term outcomes are also anticipated through the incorporation of anti-CD38 monoclonal antibodies into maintenance therapy.

Immunotherapeutic approaches such as CAR-T cell therapy and bispecific antibodies have revolutionized the treatment landscape for patients with relapsed/refractory multiple myeloma (RRMM). At IMS 2025, significant attention was given to studies evaluating the use of bispecific antibodies in combination with other anti-myeloma agents, as well as in earlier lines of treatment. As the therapeutic landscape continues to expand, there is an increasing need for studies focused on determining the optimal treatment sequence. Supported by a growing understanding of myeloma biology and enhanced tools for MRD monitoring, the field is moving towards a more targeted and risk-adapted treatment approach. The ultimate goal of this paradigm shift should be to develop truly personalized treatment strategies tailored to the individual patient.

Despite the remarkable progress achieved with immunotherapies and other novel agents over the past decade, MM remains an incurable disease for most patients. To improve outcomes for those who relapse after all available therapies, there is a pressing need for treatments with entirely new mechanisms of action. Promising developments in this respect include next-generation CAR-T constructs, trispecific antibodies, and CELMoDs such as iberdomide and mezigdomide. Furthermore, deeper insights into resistance mechanisms are essential to overcome treatment failure.

Finally, Prof Cerchione emphasizes that prevention is always better than treatment. In this regard, several large-scale studies have highlighted the potential benefits of early intervention in patients with smoldering multiple myeloma (SMM). New tools are being developed to improve risk stratification, helping to avoid overtreatment in patients unlikely to progress and enabling timely intervention in high-risk individuals with SMM.