New therapies and testing advances reshape multiple myeloma care

Multiple myeloma treatment is being reshaped by new therapies and advances in testing that are helping patients live longer and, in some cases, reach long-term remission. Research findings support more personalized therapies, identify promising immunotherapy strategies for aggressive forms of the disease, and point to new ways to refine risk assessment and treatment decisions.

Multiple myeloma is a type of blood cancer that affects plasma cells in the bone marrow. The disease can affect multiple systems in the body, often causing bone pain, anemia, kidney damage, and an increased risk of infection. Diagnosis typically begins with blood tests that detect abnormal proteins produced by myeloma cells, followed by additional testing such as bone marrow biopsy and imaging to confirm the disease.

Treatment often includes a combination of targeted therapies, immunotherapies, and, in some cases, stem cell transplant. Chemotherapy still plays a role, especially early on or in relapsed disease, but its role has been gradually decreasing as more effective targeted therapies with fewer side effects have been developed. Care strategies continue to evolve, including immunotherapy and clinical trials that study the most effective order to use available treatments.

One of the most promising advances is CAR-T therapy, which uses a patient’s own immune cells, modified in a lab to recognize and attack cancer cells. In multiple myeloma, CAR-T therapies often target B-cell maturation antigen (BCMA) found on malignant plasma cells. Clinical trials have shown strong results, particularly for patients whose disease has returned or not responded to initial treatments. CAR-T therapy has shown response rates of more than 80%, with over half of patients achieving complete remission, and has been associated with improved survival outcomes.

Newer immunotherapies such as bispecific antibodies and monoclonal antibodies are also expanding treatment options. One approach uses monoclonal antibodies given in sequence to better target cancer cells and improve outcomes for patients whose disease has returned. In one area of research, a study in the New England Journal of Medicine showed that an off-the-shelf dual-antibody immunotherapy can produce deep and durable responses in extramedullary multiple myeloma, a form of the disease with historically limited treatment options. The approach uses two engineered antibodies to engage T cells through separate immune pathways, directing an immune response against myeloma cells. The treatment is administered in a standard infusion setting, in contrast to more complex cell therapies. In early results, a majority of patients responded to the treatment, and many achieved no detectable disease, suggesting a potential new option for patients with resistant disease.

Advances in testing may also help guide treatment decisions. Standard testing uses fluorescence in situ hybridization, or FISH, which looks for specific known changes but may not capture the full picture. A newer method, Genomic Proximity Mapping (GPM), analyzes a patient’s entire genome and can identify structural changes, gains or losses of genetic material and complex rearrangements, including high-risk features. In early studies, GPM confirmed results from standard testing and identified additional clinically important changes. Researchers are now studying GPM testing in larger patient groups and exploring its use in other cancers.

Multiple myeloma has traditionally been considered incurable, but advances in treatment are helping patients live longer and, in some cases, transform the disease into more of a chronic condition. As research continues, new therapies will expand options for resistant disease and advances in testing will help support earlier, more precise care for patients.