Vision statement for multiple myeloma: Future directions

Abstract

There has been great progress in the management and patient outcome in multiple myeloma due to the use of novel agents including immunomodulatory drugs and proteasome inhibitors; nonetheless, novel agents remain an urgent need. The three promising Achilles heals or vulnerabilities to be targetted in novel therapies include: protein degradation by the ubiquitin proteasome or aggresome pathways; restoring autologous antimyeloma immunity; and targeting aberrant biology resulting from constitutive and ongoing DNA damage in tumour cells. Scientifically based therapies targeting these vulnerabilities used early in the disease course, ie smouldering multiple myeloma, have the potential to significantly alter the natural history and transform myeloma into a chronic and potentially curable disease.