Multiple myeloma is an incurable disease of malignant plasma cells and an ideal target for modern immune
therapy. The unique plasma cell biology maintained in
multiple myeloma, coupled with its hematological nature and unique bone marrow microenvironment, provide an opportunity to design specifically targeted
immunotherapies that selectively kill transformed cells with limited on-target off-
tumor effects. Broadly defined, immune
therapy is the utilization of the immune system and immune agents to treat a disease. In the context of
multiple myeloma, immune
therapy can be subdivided into four main categories: immune modulatory
imide drugs, targeted
antibodies, adoptive cell transfer
therapies, and
vaccines. In recent years, advances in all four of these categories have led to improved
therapies with enhanced antitumor activity and specificity. In
IMiDs, modified chemical structures have been developed that improve
drug potency while reducing dose limiting side effects. Targeted antibody
therapies have resulted from the development of new selectively expressed targets as well as the development of
antibody drug conjugates and
bispecific antibodies. Adoptive cell
therapies, particularly CAR-T
therapies, have been enhanced through improvements in the manufacturing process, as well as through the development of CAR constructs that enhance CAR-T activation and provide protection from a suppressive immune microenvironment. This review will first cover in-class breakthrough
therapies for each of these categories, as well as
therapies currently utilized in the clinic. Additionally, this review will explore up and coming
therapeutics in the preclinical and clinical trial stage.