A Review on Therapeutic strategies of Relapsed and Refractory Multiple Myeloma

Improvement in treatment options in multiple myeloma (MM) makes the survival rate intodouble during recent years but most of the patient eventually relapses. The treatment of relapseand refracting MM is still now very complex. At the time of relapse, the use of alternative drugsis the current practice. Using Protease inhibitors like Bortezomib and immune-modulators likethalidomide gives a satisfactory treatment prognosis in MM. Now many new options areavailable like second and third generation protease inhibitor like carfilzomib and ixazomib, theimmune-modulator like lenalidomide, pomalidomide, the monoclonal antibody likedaratumumab, elotuzumab, Histone Deacetylase inhibitor, Kinesin Spindle inhibitor and NF-kB,MAPK, AKT inhibitors. Daratumumab, targeting CD38, has multiple mechanism of action likemodulation immunosuppressive bone marrow micro-environment. Daratuzumab has a goodprogression free survival when it is given with lenalidomide/ dexamethasone orbortezomib/dexamethsone. Autologous stem cell transplantation (ASCT) is important treatmentin relapsing and refracting MM. Donor lymphocytic infusion is a new and effective technique inthe treatment of relapsing and refracting MM. The advancement in the treatment of relapsed andrefractory MM has been discussed in this article. The final goal should be finding a balancebetween efficacy, toxicity and cost.