Challenges to Overcome in Treating Multiple Myeloma

Marc J. Braunstein, MD, PhD, clinical assistant professor, Department of Medicine, co-director, Autologous Stem Cell Transplant Program, NYU Winthrop Hospital, NYU Langone Health, discusses the greatest challenge that still exists in the treatment paradigm of multiple myeloma.

The remaining challenge in multiple myeloma is that patients are still not being cured, says Braunstein. Physicians are now using multimodal approaches to treat patients with multiple myeloma and are even using monoclonal antibodies in the frontline setting similar to colleagues treating lymphomas, but the majority of patients are not cured.

There are various explanations for this, but the most prevailing explanation is that there is a myeloma stem cell that investigators are not targeting, says Braunstein. When patients are diagnosed with myeloma initially, there is a predominant clone, as well as multiple slightly different clones of the plasma cells that could be resistant to treatment and persist.

In order to overcome this challenge, we need to learn more on what drives clonal resistance, Braunstein explains, as well as how to use predictive biomarkers to select appropriate treatments for individual patients. Predictive markers could help identify the treatments that will derive the most benefit and allow longest duration of remission in each patient.