Phoenix rising, symbolizing hope in multiple myeloma treatment

Multiple Myeloma Management: Promising Advances in Treating Heavily Pretreated Patients

Lena Voss in Health & Wellness July 2025 • 4 min read.

"Explore innovative approaches in treating relapsed and refractory multiple myeloma, including the use of Pomalidomide-Dexamethasone and optimized infection management strategies."

Multiple myeloma (MM) remains a challenging hematological malignancy, particularly when patients become resistant to standard treatments. Recent research has focused on improving outcomes for these heavily pretreated individuals, exploring new therapeutic combinations and strategies to manage treatment-related complications.

This article synthesizes findings from several studies presented at a recent hematology conference, highlighting the use of pomalidomide-dexamethasone in relapsed and refractory MM (rrMM), infection risk management during monoclonal antibody therapy, and innovative approaches to treating hyperviscosity syndrome associated with plasma cell dyscrasias. Each of these areas represents a significant step forward in enhancing the quality of life and survival rates for MM patients.

By examining these targeted interventions, we aim to provide patients, caregivers, and healthcare professionals with an accessible overview of the latest advancements in MM care, offering hope and practical insights for managing this complex disease.

Pomalidomide-Dexamethasone: A New Hope for Heavily Pretreated MM

Phoenix rising, symbolizing hope in multiple myeloma treatment

Pomalidomide, a new-generation IMID (immunomodulatory drug), has shown promise in treating heavily pretreated multiple myeloma due to its oral administration and good compliance. A retrospective study evaluated the efficacy and tolerance of pomalidomide plus dexamethasone (PD) as a salvage regimen in patients with relapsed and refractory MM (rrMM), a population with particularly poor prognoses.

The study included 29 patients with rrMM who had undergone several prior treatments and were refractory to bortezomib, thalidomide, and lenalidomide. Patients received pomalidomide-dexamethasone every 28 days until disease progression. The results indicated that pomalidomide was well-tolerated, with manageable side effects.

Grade 3 anemia was observed in 48% of patients (14/29).
Grade 3 neutropenia occurred in 31% (9/29) of patients, managed with pegfilgrastim prophylaxis to avoid hospitalization and septic shocks.
Grade 3-4 thrombocytopenia without hemorrhagic events and transfusion-dependence was noted in 27% (8/29) of patients.

According to IMWG criteria, the overall response rate (ORR) was 44% (13/29), including 3 complete responses (CR), 4 very good partial responses (VGPR), and 6 partial responses (PR). When considering stable disease as a successful outcome in this heavily pretreated cohort, the ORR increased to 76% (22/29). The median overall survival (OS) from the start of pomalidomide treatment was 8 months (range 1-18), highlighting its potential to extend life even in advanced stages of the disease.

Optimizing Infection Management in the Era of Monoclonal Antibody Therapy

The introduction of monoclonal antibody therapies like elotuzumab and daratumumab has transformed the treatment landscape for multiple myeloma. However, these therapies can also increase the risk of infections. A retrospective study aimed to identify the incidence and types of infections in MM patients receiving these monoclonal antibodies to better inform infection prophylaxis strategies. The study included 51 patients treated with elotuzumab, daratumumab, or both. All patients received anti-viral prophylaxis.

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Everything You Need To Know

What is Pomalidomide-Dexamethasone, and how is it used to treat multiple myeloma?

Pomalidomide-dexamethasone (PD) is a combination therapy used to treat relapsed and refractory multiple myeloma (rrMM). The article highlights a study where 29 heavily pretreated patients, who had previously undergone several treatments and were refractory to bortezomib, thalidomide, and lenalidomide, received PD. The results indicated that Pomalidomide was well-tolerated with manageable side effects, and an overall response rate (ORR) of 44% was observed. This means that Pomalidomide-dexamethasone offers a new hope for patients who have exhausted other treatment options, and shows a potential for improving their survival.

Why is it important to optimize infection management in multiple myeloma treatment?

Monoclonal antibody therapies, like elotuzumab and daratumumab, have revolutionized multiple myeloma treatment. However, these therapies can increase the risk of infections, so optimizing infection management is critical. A study including 51 patients receiving elotuzumab, daratumumab, or both, aimed to identify the incidence and types of infections to better inform infection prophylaxis strategies. All patients received anti-viral prophylaxis. This is important because managing infections can significantly improve the quality of life and survival rates of patients undergoing monoclonal antibody therapy.

What does "relapsed and refractory multiple myeloma" mean?

The term 'relapsed and refractory multiple myeloma' (rrMM) refers to multiple myeloma that has returned after a period of remission (relapsed) or has not responded to previous treatments (refractory). In the context of the article, rrMM represents a particularly challenging stage of the disease where patients have limited treatment options. Pomalidomide-dexamethasone (PD) is presented as a potential treatment option for these heavily pretreated patients, showing promising results even in advanced stages.

What is the significance of the overall response rate (ORR) in evaluating treatment effectiveness?

The overall response rate (ORR) is a key metric used to assess the effectiveness of a treatment. It represents the percentage of patients who experience a positive response to the treatment, which can include complete responses (CR), very good partial responses (VGPR), and partial responses (PR). In the study, the ORR for Pomalidomide-dexamethasone was 44%. When stable disease was considered a successful outcome, the ORR increased to 76%. This high ORR suggests that PD can provide clinical benefit, improving the outcomes for heavily pretreated multiple myeloma patients.

What is hyperviscosity syndrome, and how does it relate to the topics discussed?

Hyperviscosity syndrome is not explicitly discussed in the provided text, but it is mentioned in the introductory paragraphs as a condition associated with plasma cell dyscrasias, which includes multiple myeloma. It is a condition where the blood becomes thicker than normal due to an excessive amount of monoclonal proteins, leading to various symptoms. The article does not provide specifics on how it is treated, but mentions that it is associated with plasma cell dyscrasias, and that the research aims to provide innovative approaches to treating hyperviscosity syndrome associated with plasma cell dyscrasias.