Immuntherapien des multiplen Myeloms

Immunotherapies have fundamentally transformed the treatment of multiple myeloma. The introduction of monoclonal antibodies such as daratumumab marked a first breakthrough and established this drug class in first-line therapy. Newer approaches, such as CAR T cells and bispecific antibodies, harness the enormous cytotoxic potential of T cells to target and eliminate cancer cells with impressive results. Ciltacabtagene autoleucel (cilta-cel), for example, has already been approved for second-line use in patients with lenalidomide-refractory disease, while bispecific antibodies offer promising options following CAR T therapy. In particular, the prospect of achieving long-lasting and deep remissions with a single infusion could lead to treatment-free intervals for patients in the future. However, immunotherapies also pose new challenges. For example, an increased rate of infection has been observed with BCMA-specific antibodies, requiring close monitoring and often polyvalent immunoglobulin substitution. Antigen loss is also a potential problem that must be considered, especially when using sequential immunotherapies. This article highlights the opportunities of immunotherapies while addressing the challenges and requirements that must be considered during treatment planning.