OnCo
cancersCancer

Multiple myeloma

Multiple myeloma is a plasma-cell cancer with more new drug classes than any other: proteasome inhibitors, IMiDs, CD38 antibodies, BCMA CAR-T, bispecifics, and an ADC.

Multiple myeloma is a cancer of antibody-producing plasma cells in the bone marrow, causing anaemia, bone destruction, kidney failure and infections. It is preceded by MGUS and smouldering myeloma, which are common (MGUS in ~3% of people over 50) and mostly harmless; whether to treat high-risk smouldering disease (AQUILA, daratumumab) is a live debate, and Iceland is screening its whole adult population (iStopMM). Staging (R-ISS/R2-ISS) and cytogenetics (del17p, t(4;14), 1q gain) drive prognosis; MRD negativity at one in a million marrow cells has become both the best prognostic marker and, since 2024, an accepted regulatory endpoint.

No cancer has gained more drug classes: proteasome inhibitors (bortezomib 2003, carfilzomib), immunomodulatory cereblon modulators (thalidomide, lenalidomide, pomalidomide; next-generation CELMoDs iberdomide and mezigdomide), CD38 antibodies (daratumumab, isatuximab), BCMA-directed CAR-T (ide-cel, cilta-cel; anito-cel decision December 2026), BCMA and GPRC5D bispecific T-cell engagers (teclistamab, elranatamab, linvoseltamab, talquetamab), a BCMA ADC (belantamab, withdrawn 2022 and re-approved 2025), plus XPO1 and BCL-2 inhibitors for subsets. Newly diagnosed patients receive a quadruplet (Dara-VRd or Isa-VRd) whether or not they proceed to autologous transplant (PERSEUS, CEPHEUS, IMROZ), then lenalidomide maintenance; median survival in fit patients now exceeds ten years. At relapse, cilta-cel (CARTITUDE-4, OS HR 0.55) and teclistamab plus daratumumab (MajesTEC-3, approved March 2026) are second-line options, with sequencing by prior antigen exposure.

The frontier is replacing transplant and indefinite maintenance with a single CAR-T infusion (CARTITUDE-5/6), MRD-guided stopping of therapy, trispecifics and combinations that pre-empt antigen escape, and CELMoDs that restore sensitivity after lenalidomide. The hard problems are high-risk cytogenetics and extramedullary disease, which respond briefly to everything; infections and prolonged cytopenias from T-cell redirection; delayed neurotoxicity after BCMA CAR-T; cost and manufacturing slots; and the fact that the disease still relapses in almost everyone eventually, so 'functional cure' remains a claim to be proven.

State of the art today

  • CAR-T in second line.
  • Bispecifics after one prior line (2026).
  • Functional cure discussions.
  • Quadruplet induction (CD38 antibody + PI + IMiD + dexamethasone) for all newly diagnosed patients, with MRD negativity in 60-75%.
  • Two antigens for T-cell redirection (BCMA, GPRC5D) with four approved bispecifics; teclistamab plus daratumumab approved at first relapse (March 2026).
  • MRD negativity accepted by FDA as an endpoint for accelerated approval (2024), enabling faster trials and MRD-guided therapy.
  • Belantamab returned after withdrawal on the strength of two positive phase 3s, a rare regulatory reversal.
  • Nationwide precursor screening (iStopMM) and precursor treatment (AQUILA) are redefining where 'myeloma care' begins.
Show survival figures (1)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • CAR-T with a survival benefit as early as second line (CARTITUDE-4, OS HR 0.55) and a third of late-line patients progression-free at five years without maintenance (CARTITUDE-1).
Who it affects
Show survival figures (2)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • Multiple myeloma causes ~190,000 new cases and ~120,000 deaths a year worldwide, ~36,000 of the cases in the US, at a median age of 69.
  • Median survival is >10 years in transplant-eligible patients and ~5-7 years in older patients.

Where the cases are

Cases by country · GLOBOCAN 2022
All countries →

Site: Multiple myeloma. World: 187,952 new cases, 121,388 deaths.

#CountryNew casesDeaths
1United States of America32,25813,067
2China30,30018,662
3India16,52614,216
4Japan6,9884,827
5Germany6,9324,514
6United Kingdom6,5043,618
7Italy6,2984,011
8Brazil5,7574,397
9France (metropolitan)5,4253,438
10Russian Federation4,8723,384

Standard of care

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Newly diagnosed

Dara-VRd ± ASCT → lenalidomide maintenance.

NCCN Guidelines: Multiple Myeloma
Whole-body MRI
Relapsed

CAR-T or bispecific; belantamab combinations; sequencing by prior exposure.

NCCN Guidelines: Multiple Myeloma
Ciltacabtagene autoleucelTeclistamabBelantamab mafodotin
MGUS / low-risk smouldering

Observation with periodic labs; no treatment outside trials.

NCCN · Observation
Smouldering myeloma / MGUSiStopMM
High-risk smouldering myeloma

Consider daratumumab monotherapy (AQUILA) or lenalidomide (E3A06), or trial enrolment; shared decision given indolent course in many.

NCCN · Category 2A (daratumumab or lenalidomide fo…
DaratumumabLenalidomideSmouldering myeloma / MGUS
Newly diagnosed, transplant-eligible

Dara-VRd (or Isa-VRd) induction × 4-6 → stem-cell collection → high-dose melphalan + autologous transplant → Dara-VRd consolidation → lenalidomide (± daratumumab) maintenance; MRD-guided de-escalation emerging (PERSEUS design). Tandem transplant or extended therapy for high risk.

NCCN · Category 1 (Dara-VRd)ESMO-MCBS · A
PERSEUSDaratumumabBortezomibLenalidomideAutologous stem cell transplant (high-dose therapy)MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)
Newly diagnosed, transplant-ineligible

Dara-VRd (CEPHEUS) or Isa-VRd (IMROZ) with bortezomib de-escalation after induction; Dara-Rd (MAIA) for frailer patients; continuous therapy with dose adjustment for frailty.

NCCN · Category 1
CEPHEUSIMROZDaratumumabIsatuximabLenalidomide
Maintenance

Lenalidomide until progression (CALGB 100104, Myeloma XI); daratumumab added for high-risk or per PERSEUS; MRD-guided discontinuation in trials (DRAMMATIC, MASTER); iberdomide maintenance (EXCALIBER) pending.

LenalidomideDaratumumabIberdomideMRD-guided treatment-free intervals in myeloma
First relapse (1-3 prior lines)

Cilta-cel if lenalidomide-refractory (CARTITUDE-4); teclistamab + daratumumab (MajesTEC-3, 2026); ide-cel after ≥2 lines; belantamab-Vd or -Pd (DREAMM-7/8); CD38-based triplets (Dara-Kd, Isa-Kd, Dara-Pd) by prior exposure; carfilzomib or pomalidomide combinations.

NCCN · Category 1 (cilta-cel ≥1 line; tec-dara ≥1 …
Ciltacabtagene autoleucelCARTITUDE-4TeclistamabMajesTEC-3Idecabtagene vicleucelKarMMa-3Belantamab mafodotinDREAMM-7DREAMM-8Carfilzomib
Triple-class refractory (≥3-4 prior lines)

BCMA CAR-T if not yet given; bispecifics (teclistamab, elranatamab, linvoseltamab; talquetamab after BCMA exposure); belantamab; selinexor-based; CELMoDs in trials; anito-cel (PDUFA Dec 2026).

TeclistamabElranatamabLinvoseltamabTalquetamabBelantamab mafodotinMezigdomideAnitocabtagene autoleucelBCMA-directed therapy → GPRC5D-directed therapy
Supportive care

Bisphosphonate or denosumab for bone disease; IVIG, antiviral, PJP prophylaxis and vaccination during T-cell redirection; thromboprophylaxis with IMiDs; renal protection; radiotherapy for painful lesions or cord compression.

Caution: T-cell redirectors and infectionsIMRT / IGRT (modern external beam)

Subtypes & biomarkers

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Subtypes
Biomarkers clinicians test

Target prevalence in this cancer

Target / alterationPrevalenceSource
BCMA
>95%
Wikipedia
CD38
>95%
Wikipedia
GPRC5D
Expression correlates with high risk
60-80%
Wikipedia

How common each drug target or alteration is in this cancer. Population-level and approximate; see the target page for detail. Full matrix.

History

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  1. 1844First described case (Solly); Bence Jones protein 1847
  2. 1958Melphalan introduced; melphalan-prednisone standard for 40 years
    Cytotoxic chemotherapy
  3. 1983High-dose melphalan with autologous marrow rescue (McElwain)
    Autologous stem cell transplant (high-dose therapy)
  4. 1996IFM 90: transplant improves survival over chemotherapy
    Autologous stem cell transplant (high-dose therapy)
  5. 1999Thalidomide shown active in refractory myeloma (Singhal, NEJM)
  6. 2003Bortezomib approved
  7. 2003Bortezomib: first proteasome inhibitor approved
    Bortezomib
  8. 2006Lenalidomide approved
    Lenalidomide
  9. 2012Carfilzomib approved; International Staging refined
    Carfilzomib
  10. 2015Daratumumab approved
  11. 2015Daratumumab: first CD38 antibody; R-ISS published
    DaratumumabR-ISS / R2-ISS staging
  12. 2019MAIA: Dara-Rd improves survival in transplant-ineligible disease
    Daratumumab
  13. 2020Belantamab mafodotin: first BCMA ADC (accelerated; withdrawn 2022)
    Belantamab mafodotin
  14. 2021Ide-cel: first myeloma CAR-T
  15. 2021Ide-cel: first myeloma CAR-T; CARTITUDE-1 shows 98% response
    Idecabtagene vicleucelCARTITUDE-1
  16. 2022Teclistamab: first myeloma bispecific
    Teclistamab
  17. 2022Teclistamab: first myeloma bispecific; cilta-cel approved
    TeclistamabMajesTEC-1Ciltacabtagene autoleucel
  18. 2023CARTITUDE-4 and KarMMa-3 move CAR-T earlier; elranatamab and talquetamab approved
    CARTITUDE-4KarMMa-3ElranatamabTalquetamab
  19. 2024PERSEUS quadruplet approved; FDA accepts MRD as an endpoint; DREAMM-7/8 positive; cilta-cel and ide-cel approved after 1-2 lines
    PERSEUSMRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)DREAMM-7DREAMM-8
  20. 2025Linvoseltamab approved; belantamab re-approved; IMROZ/CEPHEUS labels; iMMagine-1 reports 97% ORR
    LinvoseltamabLINKER-MM1Belantamab mafodotinIMROZCEPHEUSiMMagine-1
  21. 2026Teclistamab after ≥1 line; isatuximab SC
  22. 2026Teclistamab + daratumumab approved after ≥1 line (MajesTEC-3); isatuximab subcutaneous; anito-cel BLA accepted (PDUFA December)
    MajesTEC-3IsatuximabAnitocabtagene autoleucel

Pipeline

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ApprovedBispecific T-cell engager (BCMA×CD3)
Teclistamab · Tecvayli
ApprovedCAR-T (BCMA)
Ciltacabtagene autoleucel · Carvykti
Phase 3CAR-T (BCMA, D-domain binder)
Anitocabtagene autoleucel
Phase 3CELMoD (cereblon E3 ligase modulator)
Iberdomide
Phase 3CELMoD (cereblon E3 ligase modulator)
Mezigdomide
ApprovedBispecific T-cell engager (GPRC5D×CD3)
Talquetamab · Talvey
ApprovedBispecific T-cell engager (BCMA×CD3)
Linvoseltamab · Lynozyfic
ApprovedBispecific T-cell engager (BCMA×CD3)
Elranatamab · Elrexfio
ApprovedADC
Belantamab mafodotin · Blenrep
iMMagine-1CARTITUDE-5iStopMMMRD-guided treatment-free intervals in myelomaOne CAR-T infusion instead of autologous transplantBCMA-directed therapy → GPRC5D-directed therapyMRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)

Open problems

  • High-risk cytogenetics.
  • Infections with T-cell redirecting therapy.
  • Cost and access.
  • High-risk cytogenetics and extramedullary disease respond briefly to every class; no regimen closes the gap.
  • Infections are a leading cause of death on bispecifics; hypogammaglobulinaemia and T-cell exhaustion need better mitigation than IVIG and dose de-intensification.
  • Delayed neurotoxicity (parkinsonism, cranial neuropathies) after BCMA CAR-T and second primary malignancies after cereblon modulators and CAR-T.
  • Sequencing after BCMA failure: antigen loss (TNFRSF17 deletion) versus T-cell fitness; how to combine or alternate BCMA and GPRC5D agents.
  • Is transplant still needed? CARTITUDE-6 will answer; until then most fit patients receive high-dose melphalan.
  • Whether MRD-guided stopping is safe; whether MRD negativity at 10⁻⁶ equals cure for anyone.
  • Precursor disease: treating high-risk smouldering myeloma prevents progression but may over-treat; population screening's mortality effect is unknown.
  • Cost and capacity: CAR-T slots, bispecific hospitalisation for step-up dosing, and lifelong therapy costs strain every health system.

Trials

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Recruiting now (live from ClinicalTrials.gov)

Recruiting trials near you · live from ClinicalTrials.gov
Multiple myeloma
condition: multiple myeloma
Open on ClinicalTrials.gov →

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Landmark trials in OnCo

CARTITUDE-1CARTITUDE-4CARTITUDE-5CEPHEUSDREAMM-7DREAMM-8iMMagine-1IMROZiStopMMKarMMa-3LINKER-MM1MagnetisMM-3MajesTEC-1MajesTEC-3MonumenTAL-1PERSEUS

Expert centres

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Where the expertise is

Centres linked to this cancer in OnCo

Seeking a second opinion: ask your oncologist for a referral to a high-volume centre; most accept records and pathology by mail or telehealth. In the US, use the NCI's Find a Cancer Center tool or the nonprofit Cancer Commons, which navigates options for advanced cancers at no cost.

Questions to ask

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Bring to your appointment

Questions to ask your oncologist about Multiple myeloma

Generated from this cancer's standard of care, biomarkers, and pipeline · 30 questions

Newly diagnosed

  1. What is my exact diagnosis, stage, and grade, and which tests established them?
    Why: Everything else follows from an accurate stage and subtype.
  2. Which biomarkers have been tested on my tumour (for example Cytogenetics, 1q gain), R-ISS, MRD, BCMA/GPRC5D expression, Serum and urine M-protein, free light chains), and what were the results?
    Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
  3. Which subtype is my cancer, and does that change the recommended treatment?
    Why: Recognised subtypes for this cancer include Standard-risk vs high-risk cytogenetics, Transplant-eligible vs transplant-ineligible, Extramedullary disease.
  4. Is germline (inherited) genetic testing recommended for me or my family?
    Why: Inherited variants can change treatment and matter for relatives.
  5. For my situation (newly diagnosed), which of the standard options do you recommend and why?
    Why: Guideline options include: Dara-VRd ± ASCT → lenalidomide maintenance.

Relapsed

  1. For my situation (relapsed), which of the standard options do you recommend and why?
    Why: Guideline options include: CAR-T or bispecific; belantamab combinations; sequencing by prior exposure.
  2. Am I a candidate for Ciltacabtagene autoleucel, Teclistamab, Belantamab mafodotin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

MGUS / low-risk smouldering

  1. For my situation (mgus / low-risk smouldering), which of the standard options do you recommend and why?
    Why: Guideline options include: Observation with periodic labs; no treatment outside trials.
  2. How do the results of iStopMM apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

High-risk smouldering myeloma

  1. For my situation (high-risk smouldering myeloma), which of the standard options do you recommend and why?
    Why: Guideline options include: Consider daratumumab monotherapy (AQUILA) or lenalidomide (E3A06), or trial enrolment; shared decision given indolent course in many.
  2. Am I a candidate for Daratumumab, Lenalidomide, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Newly diagnosed, transplant-eligible

  1. For my situation (newly diagnosed, transplant-eligible), which of the standard options do you recommend and why?
    Why: Guideline options include: Dara-VRd (or Isa-VRd) induction × 4-6 → stem-cell collection → high-dose melphalan + autologous transplant → Dara-VRd consolidation → lenalidomide (± daratumumab) maintenance; MRD-guided de-escalation emerging (PERSEUS design). Tandem transplant or extended therapy for high risk.
  2. Am I a candidate for Daratumumab, Bortezomib, Lenalidomide, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of PERSEUS apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Newly diagnosed, transplant-ineligible

  1. For my situation (newly diagnosed, transplant-ineligible), which of the standard options do you recommend and why?
    Why: Guideline options include: Dara-VRd (CEPHEUS) or Isa-VRd (IMROZ) with bortezomib de-escalation after induction; Dara-Rd (MAIA) for frailer patients; continuous therapy with dose adjustment for frailty.
  2. Am I a candidate for Daratumumab, Isatuximab, Lenalidomide, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of CEPHEUS and IMROZ apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Maintenance

  1. For my situation (maintenance), which of the standard options do you recommend and why?
    Why: Guideline options include: Lenalidomide until progression (CALGB 100104, Myeloma XI); daratumumab added for high-risk or per PERSEUS; MRD-guided discontinuation in trials (DRAMMATIC, MASTER); iberdomide maintenance (EXCALIBER) pending.
  2. Am I a candidate for Lenalidomide, Daratumumab, Iberdomide, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

First relapse (1-3 prior lines)

  1. For my situation (first relapse (1-3 prior lines)), which of the standard options do you recommend and why?
    Why: Guideline options include: Cilta-cel if lenalidomide-refractory (CARTITUDE-4); teclistamab + daratumumab (MajesTEC-3, 2026); ide-cel after ≥2 lines; belantamab-Vd or -Pd (DREAMM-7/8); CD38-based triplets (Dara-Kd, Isa-Kd, Dara-Pd) by prior exposure; carfilzomib or pomalidomide combinations.
  2. Am I a candidate for Ciltacabtagene autoleucel, Teclistamab, Idecabtagene vicleucel or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of CARTITUDE-4 and MajesTEC-3 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Triple-class refractory (≥3-4 prior lines)

  1. For my situation (triple-class refractory (≥3-4 prior lines)), which of the standard options do you recommend and why?
    Why: Guideline options include: BCMA CAR-T if not yet given; bispecifics (teclistamab, elranatamab, linvoseltamab; talquetamab after BCMA exposure); belantamab; selinexor-based; CELMoDs in trials; anito-cel (PDUFA Dec 2026).
  2. Am I a candidate for Teclistamab, Elranatamab, Linvoseltamab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Supportive care

  1. For my situation (supportive care), which of the standard options do you recommend and why?
    Why: Guideline options include: Bisphosphonate or denosumab for bone disease; IVIG, antiviral, PJP prophylaxis and vaccination during T-cell redirection; thromboprophylaxis with IMiDs; renal protection; radiotherapy for painful lesions or cord compression.

Any stage

  1. Are there clinical trials I could join, for example of Teclistamab, Ciltacabtagene autoleucel, Anitocabtagene autoleucel, iMMagine-1?
    Why: Trials are how the next standard of care is set; asking early keeps options open.
  2. Would a second opinion at a high-volume centre change anything, and can you help arrange it?
    Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
  3. What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
    Why: Supportive care improves quality of life and helps patients complete treatment.
  4. I read that “High-risk cytogenetics”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.
  5. I read that “Infections with T-cell redirecting therapy”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Everything relevant

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Direct links plus the targets, companies, and technologies of this cancer's products.

technologies

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Allogeneic stem cell transplantationAnti-angiogenic therapyAntibody-drug conjugate (ADC)Autologous stem cell transplant (high-dose therapy)Bone-modifying agents (bisphosphonates, denosumab)Cancer-associated thrombosis prevention and treatmentCAR-T cell therapyCytotoxic chemotherapyEpigenetic drugs (HDAC, DNMT, EZH2, IDH, menin, BET)FDG PETIMRT / IGRT (modern external beam)Isolated limb perfusion and infusionMonoclonal antibodiesMRD / molecular residual disease testingMultiparameter flow cytometry MRDNGS-based MRD (clonoSEQ and molecular MRD)Palliative radiotherapyPeptide-drug & small-molecule-drug conjugatesPercutaneous hepatic perfusion (chemosaturation)PROTACs & molecular glues (targeted protein degradation)Small-molecule kinase inhibitorsT-cell engagers (bispecific)Topoisomerase-I inhibitors (and ADC payloads)Whole-body MRI

targets

6
BCMACD3CD38CXCR4GPRC5DTP53

drugs

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Phase 3CAR-T (BCMA, D-domain binder)
Anitocabtagene autoleucel
ApprovedADC
Belantamab mafodotin · Blenrep
ApprovedProteasome inhibitor
Bortezomib · Velcade
ApprovedProteasome inhibitor (irreversible)
Carfilzomib · Kyprolis
ApprovedCAR-T (BCMA)
Ciltacabtagene autoleucel · Carvykti
Not mapped hereAlkylating agent (oxazaphosphorine prodrug)
Cyclophosphamide · Cytoxan / Endoxan
ApprovedMonoclonal antibody (anti-CD38)
Daratumumab · Darzalex / Darzalex Faspro (SC)
Not mapped hereAnti-SLAMF7 monoclonal antibody
Elotuzumab · Empliciti
ApprovedBispecific T-cell engager (BCMA×CD3)
Elranatamab · Elrexfio
Phase 3CELMoD (cereblon E3 ligase modulator)
Iberdomide
ApprovedCAR-T (BCMA)
Idecabtagene vicleucel · Abecma
ApprovedMonoclonal antibody (anti-CD38)
Isatuximab · Sarclisa / Sarclisa Escena (SC)
Not mapped hereOral proteasome inhibitor (boronate)
Ixazomib · Ninlaro
ApprovedImmunomodulatory drug (cereblon E3 ligase modulator)
Lenalidomide · Revlimid
ApprovedBispecific T-cell engager (BCMA×CD3)
Linvoseltamab · Lynozyfic
Not mapped hereAlkylating agent (nitrogen mustard)
Melphalan (including hepatic delivery system) · Alkeran / Evomela / Hepzato Kit
WithdrawnPeptide-drug conjugate
Melphalan flufenamide · Pepaxto
Phase 3CELMoD (cereblon E3 ligase modulator)
Mezigdomide
WithdrawnPan-HDAC inhibitor
Panobinostat · Farydak
ApprovedCytotoxic (liposomal anthracycline)
Pegylated liposomal doxorubicin · Doxil / Caelyx
Not mapped hereOral cereblon E3 ligase modulator (IMiD)
Pomalidomide · Pomalyst / Imnovid
ApprovedSmall-molecule XPO1 (nuclear export) inhibitor
Selinexor · Xpovio
ApprovedBispecific T-cell engager (GPRC5D×CD3)
Talquetamab · Talvey
ApprovedBispecific T-cell engager (BCMA×CD3)
Teclistamab · Tecvayli
Not mapped hereOral cereblon modulator (first IMiD)
Thalidomide · Thalomid

companies

15
Adaptive BiotechnologiesAmgenBristol Myers SquibbC4 TherapeuticsGenmabGilead Sciences (incl. Kite)GSKJohnson & JohnsonKaryopharm TherapeuticsLegend BiotechOrna Therapeutics (Eli Lilly)Pfizer (incl. Seagen)RegeneronSanofiTakeda

institutions

27
American Society of HematologyCancer Center Clínica Universidad de Navarra / CIMAChristian Medical College, VelloreComprehensive Cancer Center Mainfranken, University Hospital WürzburgDana-Farber Brigham Cancer CenterEuropean Hematology AssociationGIMEMAHadassah Medical CenterHospital Clínic de Barcelona / IDIBAPSHospital Universitario 12 de OctubreHOVONIRCCS Azienda Ospedaliero-Universitaria di Bologna – Policlinico Sant'OrsolaIUCT Oncopole – Institut Universitaire du Cancer de ToulouseLeeds Cancer Centre, St James's University HospitalMayo ClinicMayo Clinic Comprehensive Cancer Center – ArizonaMD Anderson Cancer CenterMemorial Sloan Kettering Cancer CenterRambam Health Care CampusSeoul St. Mary's HospitalSylvester Comprehensive Cancer Center, University of MiamiThe Mount Sinai Hospital / Tisch Cancer InstituteThe University of Kansas Cancer CenterUnion Hospital, Tongji Medical CollegeUniversity of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterVCU Massey Comprehensive Cancer CenterWinship Cancer Institute of Emory University

pathways

2
Complement in cancerUbiquitin–proteasome system & protein homeostasis

terms

25
Autologous stem cell transplant (ASCT)B cellBone metastases and skeletal-related eventsCancer health disparities and equityCytogenetics and karyotypeCytokine release syndrome (CRS)Fixed-duration vs continuous therapyFlow cytometry (immunophenotyping)High-risk cytogenetics (myeloma)ICANS (neurotoxicity)Immunomodulatory drugs (IMiDs) and CELMoDsInduction therapyLeukaemia (tissue type)Maintenance therapyMaintenance therapyMGUS and smouldering myelomaMinimal / molecular residual disease (MRD)MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)MRD-negative complete remissionObesity-related cancers (IARC list of 13)Proteasome inhibitor (bortezomib, carfilzomib, ixazomib)R-ISS / R2-ISS stagingSmouldering myeloma / MGUSUndetectable MRD (uMRD / MRD-negative)VRd and Dara-VRd (myeloma induction regimens)

trials

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CARTITUDE-1CARTITUDE-4CARTITUDE-5CEPHEUSDREAMM-7DREAMM-8iMMagine-1IMROZiStopMMKarMMa-3LINKER-MM1MagnetisMM-3MajesTEC-1MajesTEC-3MonumenTAL-1PERSEUS

pairings

3
BCMA-directed therapy → GPRC5D-directed therapyCaution: T-cell redirectors and infectionsCD38 antibody added to PI-IMiD-dex (quadruplet induction)

ideas

17
A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compressionA watch-and-wait registry for blood precursor conditions found by chanceCollect and freeze T cells at diagnosis for high-risk patients, before chemotherapyFix the neutrophil count rule that excludes many people of African ancestryHarmonise Europe's hospital exemption for academic cell therapies, with one registryHospital-based CAR-T manufacturing at cost through a public networkHospital-made CAR-T under one shared regulatory master fileIn vivo CAR-T manufactured and priced like a generic biologicKidney and liver impairment dosing studies completed before approval, not years afterMilestone-based venture philanthropy with royalties recycled into the pipelineMRD-guided treatment-free intervals in myelomaOne CAR-T infusion instead of autologous transplantOutcome-based annuity payments for potentially curative one-time therapiesPlan the second CAR-T target before the first one is lostRapid diagnostic centres for people with vague but worrying symptomsReduce the dose once the cancer responds: response-adapted de-escalation trialsReplace fixed kidney and liver cut-offs with drug-specific, pharmacology-based thresholds

collections

2
Leukemia & Lymphoma Society (LLS)Multiple Myeloma Research Foundation (MMRF)

people

9
A. Keith StewartBenjamin L. EbertJohn F. DiPersioKenneth C. AndersonPaul G. RichardsonS. Vincent RajkumarSaad Z. UsmaniShaji K. KumarSundar Jagannath

bottlenecks

6
Dormant cells and minimal residual diseaseIncentives reward me-too drugs and marginal gainsManufacturing cost and time for living and radioactive medicinesOlder and multimorbid patients are excluded and undertreatedTrial design, endpoints and costTrials do not represent the people who get cancer

key papers

9
CARTITUDE-1: cilta-cel, a BCMA CAR-T, in heavily pretreated myelomaCARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapyCEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpointIARC verdict: excess body fat causes 13 cancersKarMMa-3: ide-cel CAR-T versus standard regimens in triple-class-exposed relapsed myelomaMagnetisMM-3: elranatamab, a second BCMA bispecific, with a switch to fortnightly dosing after responseMAIA: adding daratumumab to lenalidomide-dexamethasone for older patients with newly diagnosed myeloma who cannot have a transplantMajesTEC-1: teclistamab, an off-the-shelf BCMA bispecific antibody, in heavily pretreated myelomaPERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma

Key papers

9top
rctNature Medicine 2025changed practice
CEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpoint

CEPHEUS extends the quadruplet standard to patients who are not going to transplant, closing the gap between transplant-eligible and ineligible populations. It is also one of the first phase 3 trials to be designed around MRD-negativity as the primary endpoint, which could shorten future myeloma trials by years. Frailer patients still need dose-adapted approaches.

rctNew England Journal of Medicine 2024changed practice
PERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma

PERSEUS, with the earlier GRIFFIN and CASSIOPEIA trials, made a four-drug daratumumab quadruplet the standard for fit patients heading to transplant. It also introduced MRD-directed stopping of the antibody, a step towards treatment that is deep but not indefinite. Whether transplant itself remains necessary on top of a quadruplet is now the open question.

rctNew England Journal of Medicine 2023changed practice
CARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapy

CARTITUDE-4 is the first randomised trial to show that a CAR-T improves survival in myeloma, and it moved cilta-cel into second-line use (FDA approval 2024). For patients whose disease returns after first-line lenalidomide, a one-off cell therapy now competes with continuous drug combinations. Capacity, cost and the need for bridging therapy still limit who actually receives it.

rctNew England Journal of Medicine 2023changed practice
KarMMa-3: ide-cel CAR-T versus standard regimens in triple-class-exposed relapsed myeloma

KarMMa-3 was the first randomised evidence that CAR-T beats conventional drugs in myeloma and led to ide-cel's approval after two prior lines. It confirmed that earlier use of CAR-T produces deeper and longer remissions than in the end-stage setting. Because responses are shorter than with cilta-cel and OS was not improved, it also sharpened debate about which BCMA CAR-T to use and when.

translationalNature Medicine 2023changed practice
MagnetisMM-3: elranatamab, a second BCMA bispecific, with a switch to fortnightly dosing after response

Elranatamab confirmed that BCMA bispecifics are a class, not a one-off, and its protocol-built dose reduction after response set a precedent for lowering the immunosuppressive burden of T-cell engagers. Patients now have two approved BCMA bispecifics and one against GPRC5D (talquetamab). Choosing between them, and sequencing them with CAR-T, remains guided by availability and toxicity profile rather than head-to-head data.

translationalNew England Journal of Medicine 2022changed practice
MajesTEC-1: teclistamab, an off-the-shelf BCMA bispecific antibody, in heavily pretreated myeloma

Teclistamab showed that an off-the-shelf bispecific can approach CAR-T-like response rates in late myeloma, giving patients who cannot wait for or access cell therapy a real option. It also exposed the price: prolonged T-cell engagement causes profound immunosuppression, so infection prophylaxis and immunoglobulin replacement are now routine. Less frequent dosing after response is being adopted to reduce this burden.

translationalThe Lancet 2021changed practice
CARTITUDE-1: cilta-cel, a BCMA CAR-T, in heavily pretreated myeloma

CARTITUDE-1 showed that a single CAR-T infusion can put late-stage myeloma into deep, multi-year remission, leading to FDA approval of cilta-cel in 2022 for heavily pretreated disease. It set the efficacy bar for BCMA-directed therapy and motivated moving CAR-T earlier (CARTITUDE-4). Late neurological toxicity and secondary malignancies remain the safety questions.

rctNew England Journal of Medicine 2019changed practice
MAIA: adding daratumumab to lenalidomide-dexamethasone for older patients with newly diagnosed myeloma who cannot have a transplant

MAIA made a daratumumab-based triplet the standard first treatment for older or frail myeloma patients, replacing Rd alone. It proved an anti-CD38 antibody could improve survival, not just delay progression, when used up front. Quadruplets built on this backbone are now being tested in the same population.

reviewNew England Journal of Medicine 2016changed practice
IARC verdict: excess body fat causes 13 cancers

Maintaining a healthy weight is now established cancer prevention for over a dozen cancer types. For clinicians and policymakers, obesity belongs alongside tobacco and alcohol in prevention strategy. Whether intentional weight loss in adulthood reverses risk is still being studied, including in trials of GLP-1 drugs.

Latest papers

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Literature trend3,061 papers in the last 12 months+7% vs prior 12How this is computed
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Query for this cancer: (TITLE:"Multiple myeloma" OR ABSTRACT:"Multiple myeloma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Multiple myeloma, not a curated reading list.

Connected

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Pages like this

not linked directly; found by shared links

technologies

17
Allogeneic stem cell transplantationAntibody-drug conjugate (ADC)Autologous stem cell transplant (high-dose therapy)Bone-modifying agents (bisphosphonates, denosumab)Cancer-associated thrombosis prevention and treatmentCAR-T cell therapyCytotoxic chemotherapyFDG PETIMRT / IGRT (modern external beam)Monoclonal antibodiesMRD / molecular residual disease testingMultiparameter flow cytometry MRDNGS-based MRD (clonoSEQ and molecular MRD)Palliative radiotherapyPROTACs & molecular glues (targeted protein degradation)T-cell engagers (bispecific)Whole-body MRI

targets

6
BCMACD3CD38CXCR4GPRC5DTP53

drugs

25
Phase 3CAR-T (BCMA, D-domain binder)
Anitocabtagene autoleucel
ApprovedADC
Belantamab mafodotin · Blenrep
ApprovedProteasome inhibitor
Bortezomib · Velcade
ApprovedProteasome inhibitor (irreversible)
Carfilzomib · Kyprolis
ApprovedCAR-T (BCMA)
Ciltacabtagene autoleucel · Carvykti
Not mapped hereAlkylating agent (oxazaphosphorine prodrug)
Cyclophosphamide · Cytoxan / Endoxan
ApprovedMonoclonal antibody (anti-CD38)
Daratumumab · Darzalex / Darzalex Faspro (SC)
Not mapped hereAnti-SLAMF7 monoclonal antibody
Elotuzumab · Empliciti
ApprovedBispecific T-cell engager (BCMA×CD3)
Elranatamab · Elrexfio
Phase 3CELMoD (cereblon E3 ligase modulator)
Iberdomide
ApprovedCAR-T (BCMA)
Idecabtagene vicleucel · Abecma
ApprovedMonoclonal antibody (anti-CD38)
Isatuximab · Sarclisa / Sarclisa Escena (SC)
Not mapped hereOral proteasome inhibitor (boronate)
Ixazomib · Ninlaro
ApprovedImmunomodulatory drug (cereblon E3 ligase modulator)
Lenalidomide · Revlimid
ApprovedBispecific T-cell engager (BCMA×CD3)
Linvoseltamab · Lynozyfic
Not mapped hereAlkylating agent (nitrogen mustard)
Melphalan (including hepatic delivery system) · Alkeran / Evomela / Hepzato Kit
WithdrawnPeptide-drug conjugate
Melphalan flufenamide · Pepaxto
Phase 3CELMoD (cereblon E3 ligase modulator)
Mezigdomide
WithdrawnPan-HDAC inhibitor
Panobinostat · Farydak
ApprovedCytotoxic (liposomal anthracycline)
Pegylated liposomal doxorubicin · Doxil / Caelyx
Not mapped hereOral cereblon E3 ligase modulator (IMiD)
Pomalidomide · Pomalyst / Imnovid
ApprovedSmall-molecule XPO1 (nuclear export) inhibitor
Selinexor · Xpovio
ApprovedBispecific T-cell engager (GPRC5D×CD3)
Talquetamab · Talvey
ApprovedBispecific T-cell engager (BCMA×CD3)
Teclistamab · Tecvayli
Not mapped hereOral cereblon modulator (first IMiD)
Thalidomide · Thalomid

companies

14
Adaptive BiotechnologiesAmgenBristol Myers SquibbC4 TherapeuticsGenmabGilead Sciences (incl. Kite)GSKJohnson & JohnsonLegend BiotechOrna Therapeutics (Eli Lilly)Pfizer (incl. Seagen)RegeneronSanofiTakeda

institutions

27
American Society of HematologyCancer Center Clínica Universidad de Navarra / CIMAChristian Medical College, VelloreComprehensive Cancer Center Mainfranken, University Hospital WürzburgDana-Farber Brigham Cancer CenterEuropean Hematology AssociationGIMEMAHadassah Medical CenterHospital Clínic de Barcelona / IDIBAPSHospital Universitario 12 de OctubreHOVONIRCCS Azienda Ospedaliero-Universitaria di Bologna – Policlinico Sant'OrsolaIUCT Oncopole – Institut Universitaire du Cancer de ToulouseLeeds Cancer Centre, St James's University HospitalMayo ClinicMayo Clinic Comprehensive Cancer Center – ArizonaMD Anderson Cancer CenterMemorial Sloan Kettering Cancer CenterRambam Health Care CampusSeoul St. Mary's HospitalSylvester Comprehensive Cancer Center, University of MiamiThe Mount Sinai Hospital / Tisch Cancer InstituteThe University of Kansas Cancer CenterUnion Hospital, Tongji Medical CollegeUniversity of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterVCU Massey Comprehensive Cancer CenterWinship Cancer Institute of Emory University

pathways

2
Complement in cancerUbiquitin–proteasome system & protein homeostasis

terms

25
Autologous stem cell transplant (ASCT)B cellBone metastases and skeletal-related eventsCancer health disparities and equityCytogenetics and karyotypeCytokine release syndrome (CRS)Fixed-duration vs continuous therapyFlow cytometry (immunophenotyping)High-risk cytogenetics (myeloma)ICANS (neurotoxicity)Immunomodulatory drugs (IMiDs) and CELMoDsInduction therapyLeukaemia (tissue type)Maintenance therapyMaintenance therapyMGUS and smouldering myelomaMinimal / molecular residual disease (MRD)MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)MRD-negative complete remissionObesity-related cancers (IARC list of 13)Proteasome inhibitor (bortezomib, carfilzomib, ixazomib)R-ISS / R2-ISS stagingSmouldering myeloma / MGUSUndetectable MRD (uMRD / MRD-negative)VRd and Dara-VRd (myeloma induction regimens)

trials

16
CARTITUDE-1CARTITUDE-4CARTITUDE-5CEPHEUSDREAMM-7DREAMM-8iMMagine-1IMROZiStopMMKarMMa-3LINKER-MM1MagnetisMM-3MajesTEC-1MajesTEC-3MonumenTAL-1PERSEUS

pairings

3
BCMA-directed therapy → GPRC5D-directed therapyCaution: T-cell redirectors and infectionsCD38 antibody added to PI-IMiD-dex (quadruplet induction)

ideas

17
A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compressionA watch-and-wait registry for blood precursor conditions found by chanceCollect and freeze T cells at diagnosis for high-risk patients, before chemotherapyFix the neutrophil count rule that excludes many people of African ancestryHarmonise Europe's hospital exemption for academic cell therapies, with one registryHospital-based CAR-T manufacturing at cost through a public networkHospital-made CAR-T under one shared regulatory master fileIn vivo CAR-T manufactured and priced like a generic biologicKidney and liver impairment dosing studies completed before approval, not years afterMilestone-based venture philanthropy with royalties recycled into the pipelineMRD-guided treatment-free intervals in myelomaOne CAR-T infusion instead of autologous transplantOutcome-based annuity payments for potentially curative one-time therapiesPlan the second CAR-T target before the first one is lostRapid diagnostic centres for people with vague but worrying symptomsReduce the dose once the cancer responds: response-adapted de-escalation trialsReplace fixed kidney and liver cut-offs with drug-specific, pharmacology-based thresholds

collections

2
Leukemia & Lymphoma Society (LLS)Multiple Myeloma Research Foundation (MMRF)

people

9
A. Keith StewartBenjamin L. EbertJohn F. DiPersioKenneth C. AndersonPaul G. RichardsonS. Vincent RajkumarSaad Z. UsmaniShaji K. KumarSundar Jagannath

bottlenecks

6
Dormant cells and minimal residual diseaseIncentives reward me-too drugs and marginal gainsManufacturing cost and time for living and radioactive medicinesOlder and multimorbid patients are excluded and undertreatedTrial design, endpoints and costTrials do not represent the people who get cancer

key papers

9
CARTITUDE-1: cilta-cel, a BCMA CAR-T, in heavily pretreated myelomaCARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapyCEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpointIARC verdict: excess body fat causes 13 cancersKarMMa-3: ide-cel CAR-T versus standard regimens in triple-class-exposed relapsed myelomaMagnetisMM-3: elranatamab, a second BCMA bispecific, with a switch to fortnightly dosing after responseMAIA: adding daratumumab to lenalidomide-dexamethasone for older patients with newly diagnosed myeloma who cannot have a transplantMajesTEC-1: teclistamab, an off-the-shelf BCMA bispecific antibody, in heavily pretreated myelomaPERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma