Addressing the gap in research across diverse ethnicities, a new population-based study utilized data from the National Health and Nutrition Examination Survey (NHANES) involving 373 monoclonal gammopathy of undetermined significance (MGUS) cases and 1,406 controls. The study evaluated dietary impacts on MGUS risk using a 24-hour dietary recall method to assess intake of various food groups, adjusting for multiple demographic factors.

The findings indicate significant dietary associations with MGUS risk. High consumption of whole-grain bread, oats, rice, fruits, vegetables, tomatoes, and cruciferous vegetables correlated with a 28-78% reduction in MGUS risk. Conversely, intake of sugar- and artificially sweetened beverages was associated with a 34-113% increase in risk. Notably, the impact of diet appeared more pronounced in cases of low-risk MGUS (LRMGUS) compared to intermediate/high-risk MGUS (IHRMGUS), suggesting underlying etiological differences between these classifications. These results underscore the potential of dietary modifications in managing MGUS risk.

Reference: Joseph J, Tang L, Jens H, et al. Risk of MGUS, a multiple myeloma precursor, in relation to food and beverage intake in the National Health and Nutrition Examination Survey (NHANES). Journal of Clinical Oncology. 2023; 41. e20062-e20062. 10.1200/JCO.2023.41.16_suppl.e20062.

Researchers of a study developed a transcriptomic atlas mapping normal plasma cell development, elucidating the distinct biological trajectories of light-chain amyloidosis (AL) and multiple myeloma (MM) cells. The findings show AL plasma cells resemble those from secondary lymphoid organs, while MM cells align more with peripheral blood and newborn bone marrow plasma cells. This variation explains their different clinical impacts—AL leads to organ-impacting amyloid fibrils independently of tumor burden, whereas MM causes significant bone marrow proliferation and associated complications like anemia and bone damage.

Additionally, leveraging cutting-edge single-cell RNA sequencing, the study examines the heterogeneity and transcriptional programs (TPs) of tumor plasma cells in both diseases, identifying specific TPs linked to their origins and behaviors. Notably, variations in gene expression related to protein glycosylation and ribosome biogenesis provide insights into the distinct pathologies of AL and MM, despite some genetic overlaps. These findings reveal complex interactions between a tumor's genetic profile and its microenvironment.

Reference: Corre J. Why is amyloidosis not multiple myeloma? Blood. Updated October 28, 2021. Accessed May 13, 2024. https://ashpublications.org/blood/article/138/17/1514/477397/Why-is-amyloidosis-not-multiple-myeloma

MagnetisMM-1 is an ongoing Phase 1 first-in-human study evaluating subcutaneous elranatamab, a BCMA/CD3 bispecific antibody, in patients with relapsed or refractory multiple myeloma. In this analysis, 55 patients received single-agent elranatamab at doses of at least 215 μg/kg. The population was heavily pretreated, with a median of 5 prior regimens; 91% were triple-class refractory, 69% had prior stem cell transplantation, 29% had high-risk cytogenetics, and 24% had received prior BCMA-targeted therapy. Common treatment-emergent adverse events included cytokine release syndrome, neutropenia, anemia, injection-site reaction, and lymphopenia. With premedication and a single priming dose, CRS at the recommended dose was limited to grade 1 or 2, with no grade 3 or higher events reported.

Elranatamab showed clinical and molecular activity in this difficult-to-treat population. With a median follow-up of 12 months, the objective response rate was 64%, with 56% of patients achieving very good partial response or better and 38% achieving complete response or better. Among patients with prior BCMA-directed therapy, 54% responded. Median response time was 36 days, and the estimated median duration of response was 17.1 months. All evaluable patients with confirmed complete response or better achieved minimal residual disease negativity at a sensitivity of 1 × 10⁻⁵. The authors conclude that these findings support continued development of elranatamab for patients with relapsed or refractory multiple myeloma.

Reference: Raje N, Bahlis NJ, Costello C, et al. Elranatamab, a BCMA targeted T-cell engaging bispecific antibody, induces durable clinical and molecular responses for patients with relapsed or refractory multiple myeloma. Blood. 2022 Nov 15;140(Suppl 1):388-390. doi: 10.1182/blood-2022-166494.

This article reviews the role of minimal residual disease (MRD) testing in multiple myeloma (MM), highlighting its association with improved progression-free survival and overall survival. MRD-negative status correlates with better long-term outcomes, and advances in next-generation sequencing and flow cytometry have enhanced MRD detection. While MRD testing provides important prognostic information, its role in guiding treatment decisions outside of clinical trials is still under investigation, and more research is needed to establish its clinical utility.

The authors also discuss a clinical case of a patient with monoclonal gammopathy of undetermined significance who remained MRD-negative for two years after autologous stem cell transplant but tested positive for low-level MRD at the five-year mark. Despite the MRD positivity, the patient chose to continue her current therapy. This case underscores the challenges of interpreting MRD results. It also highlights the need for further studies to determine how MRD testing, along with functional imaging and liquid biopsies, can be effectively integrated into clinical decision-making.

Reference: Yee AJ, Raje N. Minimal Residual Disease in Multiple Myeloma: Why, When, Where. Hematology Am Soc Hematol Educ Program. 2021;2021(1):37-45. doi: 10.1182/hematology.2021000230.

Authors of this article discuss the role of frailty assessments in managing older adults with multiple myeloma (MM). Frailty scores, including the IMWG score, are valuable tools for predicting treatment tolerance and guiding decisions regarding stem cell transplant and non-transplant therapies. The IMWG score and other frailty scales incorporate age, comorbidities, and physical performance to determine the patient's fitness level and potential for treatment-related toxicity. This approach helps clinicians tailor treatments, considering both biological age and disease factors. The case study of a 70-year-old woman highlights how frailty scoring influences treatment decisions, as she was classified as intermediate-fit, which informed her personalized therapy plan, including reduced-intensity treatments.

Researchers also explore the challenges of applying frailty scoring in clinical practice, particularly when deciding between transplant and non-transplant strategies. While frailty scores offer important insights, their limitations mean that clinical decisions still rely on patient preferences, life expectancy, and disease biology. The case study emphasizes the importance of shared decision-making, as the patient, despite being classified as intermediate-fit, opted for non-transplant therapy. Ongoing studies are needed to refine these tools and incorporate them into routine clinical practice.

Reference: Grant SJ, Freeman CL, Rosko AE. Treatment of Older Adult or Frail Patients with Multiple Myeloma. Hematology Am Soc Hematol Educ Program. 2021;2021(1):46-54. doi: 10.1182/hematology.2021000231.

The MASCOT cohort study explores the influence of physical activity and fitness on the quality of life, bone health, and fatigue in patients with multiple myeloma (MM). It evaluates patients in the plateau phase of MM, tracking their physical activity, fitness, bone health, and fatigue at baseline and then at 3, 6, and 12 months. Clinical health markers, psychological and physical well-being, and lifestyle behaviors will be assessed using objective measures such as cardiopulmonary exercise testing (CPET) and accelerometers, as well as self-report questionnaires. It will also identify the stages in the MM treatment process where physical activity interventions could be most beneficial.

This study is crucial in understanding the role of physical activity in the recovery and quality of life of MM patients. Findings from the MASCOT study provide valuable insights into developing tailored exercise interventions and lifestyle recommendations for MM patients, potentially improving their long-term health outcomes and quality of life.

Reference: Heinrich M, Fisher A, Paton B, et al. Lifestyle in Multiple Myeloma - a longitudinal cohort study protocol. BMC Cancer. 2016 Jul 4;16:387. doi: 10.1186/s12885-016-2407-x. PMID: 27377407; PMCID: PMC4932746.

Patients with multiple myeloma (MM) face a significantly elevated risk of infections due to disease-related immune dysfunction and the effects of antimyeloma therapy. Researchers of this meta-analysis, incorporating 35 studies (12 quantitatively), found that patients with MM had substantially lower antibody and T-cell responses to COVID-19 vaccines compared to healthy controls. Subgroup analysis confirmed reduced seroconversion rates after each vaccine dose. While boosters improved immunity in some, overall responses remained impaired. Only a small percentage of patients with MM developed effective antibody titers, and T-cell studies showed reduced cytokine production and cytotoxic function, particularly compared to patients with less advanced plasma cell disorders.

Clinically, vaccinated patients with MM still experienced breakthrough COVID-19 infections, with reported rates ranging from 0.87% to 17.4%. Some had no detectable antibodies at the time of infection, while others developed delayed serologic responses. These outcomes reflect MM’s profound immune dysregulation—marked by impaired B- and T-cell function, disrupted dendritic cell activity, and an immunosuppressive tumor environment. Unlike previous reviews, this study evaluated both humoral and cellular immunity as well as clinical outcomes, providing a more complete picture. The findings highlight the need for enhanced vaccination strategies, closer monitoring, and further research to improve protection for patients with MM.

Reference: Harandi H, Fallahtafti P, Karimi A, et al. Examining the immunological responses to COVID-19 vaccination in multiple myeloma patients: a systematic review and meta-analysis. BMC Geriatr. 2024;24:411. doi: 10.1186/s12877-024-05006-0.

Monoclonal gammopathies can overlap, but the true frequency and impact of coexisting systemic amyloid light-chain (AL) amyloidosis and multiple myeloma (MM) remain unclear. This referral-center study prospectively enrolled all patients with AL treated from January 2005 to April 2023, identifying 141 total cases (7 localized; 134 systemic). Systemic AL was dominated by cardiac involvement (90.3%), with kidneys (45.5%) and bone marrow (40.3%) also commonly affected. Median diagnostic delay was 6 months and treatment began a median of 19 days after biopsy. Using IMWG criteria, 25/134 systemic patients with AL (18.7%) met criteria for MM (mostly synchronous AL/MM rather than a second primary developing later). These patients had higher free light chain ratios/differences and higher marrow plasma cell percentages, but similar rates of cardiac involvement compared with AL-only patients.

Outcomes were driven far more by cardiac disease severity than by the presence of MM. Median overall survival trended shorter with AL/MM vs AL alone (35.5 vs 52.6 months), but the difference was not statistically significant, likely reflecting sample size and cohort heterogeneity. In multivariable modeling, independent prognostic factors were age, very high NT-proBNP (≥8500), and undergoing autologous stem cell transplant (ASCT), with left ventricular ejection fraction showing only a marginal effect. Patients with NT-proBNP ≥8500 had dramatically worse survival, while ASCT candidates had markedly better outcomes. The authors argue that clinicians should actively evaluate for coexisting AL and MM—especially in newly diagnosed MM where AL may be underrecognized—and call for larger prospective studies and dedicated trials to clarify the biology, optimal workup, and prognostic impact of AL/MM overlap.

Reference: Ríos-Tamayo R, Krsnik I, Gómez-Bueno M, et al. AL Amyloidosis and Multiple Myeloma: A Complex Scenario in Which Cardiac Involvement Remains the Key Prognostic Factor. Life (Basel). 2023 Jul 6;13(7):1518. doi: 10.3390/life13071518. PMID: 37511893; PMCID: PMC10382070.

In a phase 1/2 study, researchers evaluated subcutaneous teclistamab, a CD3×BCMA bispecific T-cell–redirecting antibody, in heavily pretreated relapsed/refractory multiple myeloma. Patients (n=165) had received at least 3 prior lines with exposure to an immunomodulatory drug, proteasome inhibitor, and anti-CD38 antibody (78% triple-class refractory; median 5 prior lines). After step-up priming (0.06, 0.3 mg/kg), patients received 1.5 mg/kg weekly. At a median 14.1-month follow-up, overall response rate was 63%, with 39% achieving complete response or better; 27% achieved minimal residual disease (MRD) negativity overall, and MRD negativity among those with at least a complete response was 46%. Median duration of response was 18.4 months, and median progression-free survival was 11.3 months.

Toxicities reflected T-cell redirection but were largely low grade for syndromic events: cytokine release syndrome occurred in 72% (grade 3, 0.6%; none grade 4) and neurotoxicity in 14.5% (immune effector cell–associated neurotoxicity syndrome [ICANS] 3%, all grade 1–2). Cytopenias were common (neutropenia 71% [grade 3–4, 64%], anemia 52% [37%], thrombocytopenia 40% [21%]), and infections were frequent (76%; grade 3–4, 45%). Overall, teclistamab produced deep, durable responses in triple-class–exposed myeloma with manageable cytokine release syndrome/ICANS. However, the high rates of cytopenias and infections underscore the need for proactive monitoring and supportive care. Together, these data support teclistamab as a later-line option for triple-class–exposed patients while highlighting the importance of structured infection prophylaxis and close surveillance.

Reference: Moreau P, Garfall AL, van de Donk NWCJ, et al. Teclistamab in Relapsed or Refractory Multiple Myeloma. N Engl J Med. 2022;387(6):495-505. doi: 10.1056/NEJMoa2203478.

This study examined 81 affected males from 19 pedigrees with X-linked ocular albinism (XLOA) to better define the range of clinical findings. The authors found that visual acuity varied widely, even within the same family, but was often better than might be expected: nearly 80% of patients had vision of 6/36 or better, and many had good near vision. Vision did not worsen with age. Nystagmus was present in nearly all patients, strabismus was common, and refractive errors—especially astigmatism—were frequent. The study also found consistent structural eye findings, including marked iris translucency, foveal hypoplasia, abnormal foveal vascular patterns, and frequent optic disc abnormalities. Better vision tended to be associated with greater pigmentation at the posterior pole, and skin biopsies showed macromelanosomes in nearly all tested patients.

The discussion emphasizes that XLOA is often misdiagnosed, particularly as congenital motor nystagmus, and should be considered in any male infant who presents with nystagmus. The authors note that the most useful clinical clues are nystagmus, marked iris translucency, and foveal hypoplasia, though none of these findings alone are fully diagnostic. They suggest reduced vision in XLOA likely reflects multiple factors, especially foveal hypoplasia, nystagmus, and sometimes optic nerve abnormalities, with refractive error potentially contributing as well. The paper also highlights the value of examining the mother for carrier signs and using tests such as visual evoked potentials and skin biopsy to help distinguish XLOA from other inherited disorders that can present with infantile nystagmus.

Reference: Charles SJ, Green JS, Grant JW, Yates JR, Moore AT. Clinical features of affected males with X linked ocular albinism. Br J Ophthalmol. 1993 Apr;77(4):222-7. doi: 10.1136/bjo.77.4.222. PMID: 8494858; PMCID: PMC504486.

This review synthesizes evidence on lifestyle domains—physical activity, weight management/nutrition, sleep, and substance use—in multiple myeloma (MM). Exercise is generally safe and feasible during and after treatment and, in small trials and pilots, has improved fatigue, strength, aerobic fitness, and quality of life. However, MM-specific data remain limited, and disability from bone disease, older age, and treatment effects suppress activity levels. Given lytic lesions and fracture risk, programs should be individualized with physical therapy/rehab input and bone-directed therapy where indicated.

Excess adiposity is linked to higher MM incidence and may worsen outcomes, underscoring the need for weight control and nutrition counseling. Body mass index alone can miss sarcopenic obesity, so body-composition assessment is valuable and common deficiencies (eg, vitamin D, folate) warrant monitoring. Sleep problems are prevalent due to pain, corticosteroids, neuropathy, and mood disorders. Sleep-disordered breathing appears common, and sleep hygiene, cognitive behavioral therapy for insomnia, and exercise can help. Smoking shows no clear association with MM risk, while observational data hint at a protective effect of light/moderate alcohol, but guidance still favors avoidance or strict limits. Cannabis may relieve symptoms but carries risks and legal issues—so counseling should be cautious and individualized within multidisciplinary plans emphasizing safe activity, weight/nutrition support, and sleep optimization, with rigorous trials needed to clarify effects on disease outcomes.

Reference: Shapiro YN, Peppercorn JM, Yee AJ, et al. Lifestyle considerations in multiple myeloma. Blood Cancer J. 2021;11(10):172. doi: 10.1038/s41408-021-00560-x.

This review summarizes major toxicities of BCMA-directed CAR-T in relapsed/refractory multiple myeloma and aligns management with consensus guidance and pivotal trials. For cytokine release syndrome (CRS), it reviews the mechanism (CAR-T activation → macrophage cytokine surge, especially IL-6/IL-1), typical features (fever; grading driven by hypotension/hypoxia), and why ASTCT grading is the practical standard. Across studies, CRS is common but usually low grade—earlier with ide-cel (median onset ~1 day) and later with cilta-cel (~7–8 days). Management is risk- and product-based: supportive care for mild CRS, earlier escalation in high-risk settings, and tocilizumab ± corticosteroids for grade ≥3 or persistent/worsening CRS, with anakinra often used for refractory cases.

Neurotoxicity is framed as the second core toxicity, spanning ICANS (cytokine-driven endothelial activation and blood–brain barrier disruption) and delayed “non-ICANS” syndromes (movement/neurocognitive effects, cranial nerve palsies) more associated with cilta-cel and possibly on-target/off-tumor effects. Rates are generally lower than lymphoma CAR-T. ICANS is usually early, while non-ICANS events can be delayed, and later cilta-cel trials emphasize cytoreduction plus early CRS/ICANS treatment. The review also covers hematotoxicity and infection prevention (including cautious G-CSF timing, thrombopoietin agonists or stem cell boosts, prophylaxis/vaccines, IVIG thresholds) and less common complications (coagulopathy, transient CRS-linked cardiotoxicity, rare secondary malignancies). Researchers argue that earlier CAR-T use, smarter bridging/cytoreduction, and better biomarkers/monitoring can expand safer outpatient delivery while minimizing toxicity.

Reference: Afrough A, Abraham PR, Turer L, et al. Toxicity of CAR T-Cell Therapy for Multiple Myeloma. Acta Haematol. 2025;148(3):300-314. doi: 10.1159/000539134. Epub 2024 May 8. PMID: 38718775; PMCID: PMC12112896.

This article summarizes major multiple myeloma data presented at the 67th American Society of Hematology Annual Meeting, with a focus on bispecific antibodies moving into earlier lines of care. In the Phase 3 MajesTEC-3 trial, teclistamab plus daratumumab significantly improved progression-free survival compared with daratumumab-based triplet regimens in patients with relapsed/refractory multiple myeloma who had received 1 to 3 prior therapies. At 36 months, estimated progression-free survival was 83.4% with teclistamab-daratumumab vs 29.7% with DPd or DVd, with higher complete response, overall response, and minimal residual disease negativity rates also reported. However, serious adverse events and infection risk remain important considerations. The findings raise questions about how best to sequence therapies as bispecifics move earlier in treatment.

The article also highlights emerging data for linvoseltamab, another bispecific antibody, across multiple treatment settings. In LINKER-MM4, linvoseltamab showed early activity in newly diagnosed multiple myeloma, supporting interest in using highly active therapies earlier, especially for transplant-ineligible patients who may not reach later lines of therapy. Additional studies explored linvoseltamab with anti-CD38 therapy and as immunoconsolidation for patients who remained MRD positive after initial treatment. While these results suggest growing momentum for bispecifics in broader multiple myeloma care, they also underscore practical challenges, including infection management, community readiness, emergency care awareness, and payer considerations as these therapies become more widely used.

Reference: CaffreyM. Bispecifics in New Combos, New Uses, and Earlier Lines of Treatment in Myeloma. AJMC. Published December 15, 2025. Accessed May 27,2026. https://www.ajmc.com/view/bispecifics-in-new-combos-new-uses-and-earlier-lines-of-treatment-in-myeloma 

This review emphasizes the necessity of a multi-faceted approach in treating multiple myeloma (MM), incorporating conventional and complementary methods to address the comprehensive needs of patients. It advocates for the incorporation of dietary modifications, lifestyle interventions, and the use of various supplements that have shown potential in both preclinical and clinical settings to alleviate symptoms and possibly improve treatment outcomes. Moreover, it highlights the widespread use of complementary treatments among patients, often without their doctors' knowledge, which could lead to interactions with standard treatments. 

Establishing evidence-based guidelines and enhancing patient-practitioner communication are crucial to safely integrating these therapies into standard care, ensuring they are used effectively and without compromising the efficacy of conventional treatments.

Reference: Andreazzoli F, Levy Yurkovski I, Ben-Arye E, Bonucci M. Conceptualizing an Integrative Multiple Myeloma Care: The Role of Nutrition, Supplements, and Complementary Modalities. Nutrients. 2024; 16(2):237. https://doi.org/10.3390/nu16020237.

This study focused on the evolution of treatment options for multiple myeloma, which now include immunomodulatory agents (IMiDs), proteasome inhibitors (PIs), monoclonal antibodies (mAbs), and a histone deacetylase inhibitor (HDACi). The study analyzed pivotal clinical trials to understand the side effects of these drugs – emphasizing the importance of considering the side effects within the context of the disease, drug combinations, and supportive measures – and discussed strategies for their prevention and management. The study also highlighted the need for consistent reporting standards for adverse events (AEs) to better understand their quality, incidence, and severity.

Researchers underscored the importance of monitoring for thromboembolic complications, peripheral neuropathy, and infusion-related reactions, especially with mAbs like elotuzumab and daratumumab. Management strategies include dose modifications, prophylactic measures, and patient education regarding risks and symptoms. This comprehensive understanding of the side effects and management strategies associated with novel myeloma therapies is crucial for optimizing patient outcomes and minimizing treatment-related complications.

Reference: Ludwig H, Delforge M, Facon T, etal. Prevention and management of adverse events of novel agents in multiple myeloma: a consensus of the European Myeloma Network.  Leukemia. 2018 Jul;32(7):1542-1560. doi: 10.1038/s41375-018-0040-1. Epub 2018 May 2. PMID: 29720735; PMCID: PMC6035147.

This analysis of the UK NCRI Myeloma XI trial examined how age influences outcomes in newly diagnosed multiple myeloma and how the relative importance of disease-related vs patient-related factors changes over time. Among 3894 patients, older age was strongly associated with shorter progression-free and overall survival, with especially poor outcomes in patients older than 80 years. As age increased, performance status worsened, renal function declined, beta-2 microglobulin rose, and more patients fell into higher ISS stages. Although high-risk molecular abnormalities remained prognostic across age groups, their impact lessened with advancing age, while the influence of ISS increased. The findings suggest that in younger patients, tumor biology plays a larger role in determining outcome. In older patients, broader clinical factors become increasingly important.

The study also found that performance status retained prognostic value at every age, supporting the idea that physical frailty may be a more meaningful predictor of outcome than age alone. In the very elderly, some commonly used molecular risk models appeared less informative, raising concerns about relying too heavily on tumor-based risk scores in older patients. The authors argue that risk assessment and treatment planning should shift with age: younger patients may benefit most from strategies targeting high-risk disease biology, while older patients may need more individualized approaches that account for frailty, clinical condition, and treatment tolerance. Overall, the study highlights the need for age-adapted, personalized care models in multiple myeloma rather than a one-size-fits-all approach.

Reference: Pawlyn C, Cairns D, Kaiser M, et al. The relative importance of factors predicting outcome for myeloma patients at different ages: results from 3894 patients in the Myeloma XI trial. Leukemia. 2020 Feb;34(2):604-612. doi: 10.1038/s41375-019-0595-5. Epub 2019 Oct 14. PMID: 31611625; PMCID: PMC7214257.

Researchers assessed patients with multiple myeloma (MM) and their vulnerable to infections, including COVID-19, due to the disease and treatments compromising their immune system. This vulnerability is exacerbated by age, frailty, comorbidities, and treatments like immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), CD38-directed monoclonal antibodies, and BCMA-directed therapies, which further weaken the immune response to pathogens. The COVID-19 pandemic significantly impacted patients with MM, who are at increased risk for severe outcomes.

SARS-CoV-2 variants pose ongoing challenges, with the newer strains causing concern about vaccine effectiveness and treatment efficacy. Patients with MM, particularly those undergoing certain therapies like anti-BCMA treatments, show suboptimal vaccine response and heightened risk of severe COVID-19. To mitigate this, vaccination, including booster shots, is crucial, though effectiveness varies based on treatment regimens and patient factors. Oral antivirals and remdesivir have proven effective in treating COVID-19 in patients with MM, but options like convalescent plasma are not recommended due to limited data. The management of MM during COVID-19 requires personalized approaches, considering factors such as disease status, treatment, and vaccination. Emerging strategies like artificial neural networks may soon aid in predicting outcomes for patients with MM and COVID-19.

Reference: Terpos E, Musto P, Engelhardt M, et al. Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN). Leukemia. 2023 Jun;37(6):1175-1185. doi: 10.1038/s41375-023-01920-1. Epub 2023 May 4. PMID: 37142661; PMCID: PMC10157596.

Bispecific antibodies (BsAbs) are reshaping the treatment landscape for relapsed/refractory multiple myeloma (RRMM), offering high response rates and durable remissions, especially in heavily pretreated patients. These therapies engage T cells to kill malignant plasma cells by targeting specific antigens such as BCMA, GPRC5D, FcRH5, and CD38. Agents like teclistamab, elranatamab, and talquetamab have demonstrated strong efficacy as monotherapies and in combination with other anti-myeloma drugs. Supportive strategies—like immunoglobulin replacement, antimicrobial prophylaxis, and growth factor support—are essential to reduce treatment-related complications.

Encouraged by their success in RRMM, BsAbs are now being studied in earlier treatment settings where patients have better T-cell function. Trials in newly diagnosed myeloma, post-transplant consolidation, and high-risk smoldering myeloma aim to capitalize on this improved immune profile. Still, resistance remains a key challenge, driven by factors like T-cell exhaustion and antigen loss. Combinations with immunomodulators, checkpoint inhibitors, and agents like cyclophosphamide show promise in enhancing efficacy. BsAbs also offer practical advantages over chimeric antigen receptor T-cell therapy, including off-the-shelf availability and fewer severe immune-related toxicities. As research progresses, optimizing sequencing, duration, and combination strategies will be key to realizing the full potential of BsAbs in multiple myeloma.

Reference: Devasia AJ, Chari A, Lancman G. Bispecific antibodies in the treatment of multiple myeloma. Blood Cancer J. 2024;14(1):158. doi: 10.1038/s41408-024-01139-y.

In a comprehensive study at a referral center, 141 patients with systemic light chain (AL) amyloidosis were analyzed, revealing that 25 (18.7%) also met the diagnostic criteria for multiple myeloma (MM). This co-occurrence frequently manifests simultaneously rather than as sequential primary malignancies. Despite the common origin of clonal malignant plasma cells, AL and MM diverge significantly in clinical presentation.

The study underscores the varied impact of AL and MM on patient outcomes, with those having both conditions showing poorer survival rates, though not statistically significant due to sample size limitations. Heart involvement, predominantly observed in AL cases, significantly influences prognosis. Independent prognostic factors identified include age, levels of N-terminal pro-brain natriuretic peptide, and undergoing autologous stem cell transplant, highlighting the need for targeted therapeutic strategies. This research emphasizes the necessity for ongoing study to refine diagnostic criteria and treatment protocols, particularly in recognizing and managing the complexities when both conditions present simultaneously.

Reference: Ríos-Tamayo R, Krsnik I, Gómez-Bueno M, et al. AL Amyloidosis and Multiple Myeloma: A Complex Scenario in Which Cardiac Involvement Remains the Key Prognostic Factor. Life (Basel). 2023 Jul 6;13(7):1518. doi: 10.3390/life13071518. PMID: 37511893; PMCID: PMC10382070.

Dietary interventions, particularly those impacting the gut microbiome, are shown to have potential effects on multiple myeloma (MM) incidence and quality of life. This necessitates the development of evidence-based dietary guidelines for those at risk for MM, including individuals with Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM).

Research underscores the role of plant-based diets in reducing MM risk, as indicated by the significant findings from the EPIC-Oxford cohort and Oxford Vegetarian study, due to their impact on the microbiome's function and immune system interactions. These findings support the need for oncologists to actively engage with patients about their dietary habits as part of comprehensive cancer care. This engagement helps to tailor interventions that may mitigate disease progression and enhance the quality of life for patients with MM. Furthermore, these insights drive the need for continued research into the mechanisms by which diet and microbiome affect MM.

Reference: Shah UA, Parikh R, Castro F, Bellone M, Lesokhin AM. Dietary and microbiome evidence in multiple myeloma and other plasma cell disorders. Leukemia. 2023 May;37(5):964-980. doi: 10.1038/s41375-023-01874-4. Epub 2023 Mar 30. PMID: 36997677; PMCID: PMC10443185.

Existing studies, like the EPIC-Oxford cohort and Oxford Vegetarian study, have indicated that plant-based diets significantly lower multiple myeloma risk compared to meat-heavy diets. Conversely, the Nurses’ Health Study and Health Professionals Follow-up Study noted an increased MM risk linked to pro-inflammatory diets among men. To build on this sparse data, the NIH-AARP Diet and Health study, a large prospective cohort, examined the relationship between pre-diagnosis diets and MM incidence among over 392,000 participants, highlighting the potential protective role of healthful plant-based diets.

The NIH-AARP study uniquely quantified dietary patterns using indices like the Healthy Eating Index-2015 and the healthful Plant-based Diet Index, finding that higher adherence to plant-based diets was associated with a reduced MM risk. This large-scale epidemiologic analysis, the most extensive to date, supports the idea that dietary choices may significantly influence MM risk. The results underscore the necessity for oncologists to discuss dietary habits with their patients as part of a comprehensive care strategy.

Reference: Castro F, Parikh R, Eustaquio JC, et al. Pre-Diagnosis Dietary Patterns and Risk of Multiple Myeloma in the NIH-AARP Diet and Health Study. medRxiv [Preprint]. 2023 Sep 23:2023.09.20.23295639. doi: 10.1101/2023.09.20.23295639. Update in: Leukemia. 2023 Dec 29;: PMID: 37790335; PMCID: PMC10543062.