Unveiling Multiple Myeloma: From "The Great Mimicker" to a Controllable Chronic Disease

1. Beware of "The Great Mimicker" in the Hematologic System

Multiple Myeloma (MM) is the second most common hematological malignancy worldwide and the third most common in China. It originates from plasma cells in the bone marrow, which are "immune warriors" that normally synthesize antibodies to fight infection. When these cells become malignant, they proliferate uncontrollably, crowding out healthy cells and destroying bone and kidney functions. Due to its insidious onset and diverse symptoms, the misdiagnosis rate is as high as 50%.

The typical clinical signs are summarized as the "CRAB" symptoms:

· C (Calcium high): Hypercalcemia.

· R (Renal impairment): Kidney damage.

· A (Anemia): Low red blood cell count.

· B (Bone disease): Bone pain or pathological fractures.

2. Treatment Breakthroughs: The Rise of CAR-T Therapy

Previously, the median survival for MM patients was only 3–5 years. Today, with the application of targeted drugs and immunotherapy, average survival is expected to reach 10 years or more. Professor Du Juan highlights CAR-T cell therapy as one of the most effective treatment options currently available:

· Dual-Target Precision: BCMA/CD19 dual-target CAR-T covers the vast majority of myeloma plasma cells and addresses potential "stem-like" characteristics of the disease to prevent relapse.

· Deep Remission: Clinical studies reported an Overall Response Rate (ORR) of 100% and a Minimal Residual Disease (MRD) negativity rate of 100%.

· Superior Safety: These protocols show a lower incidence of Cytokine Release Syndrome (CRS) with no observed severe (Grade 3+) neurotoxicity (ICANS).

3. Advanced Clinical Strategies

Professor Du provides a forward-looking roadmap for modern MM management:

· Early Intervention for High-Risk Groups: For newly diagnosed high-risk patients (including transplant-eligible and elderly transplant-ineligible patients), initiating CAR-T therapy after two cycles of VRd induction (Bortezomib, Lenalidomide, and Dexamethasone) has shown significant clinical benefits over conventional frontline protocols.

· Strategic Sequencing: It is generally recommended to utilize CAR-T therapy first; if the disease progresses, bispecific antibodies (BsAbs) can then be employed.

· Bridging Therapy: For patients who cannot wait for the CAR-T manufacturing period, BsAbs can serve as a brief "bridging" tool to reduce tumor burden without compromising CAR-T efficacy.

· Maintenance: Maintenance therapy remains a vital strategy for high-risk patients or those who have not achieved the deepest possible remission after CAR-T.

4. Critical Reminders

· Regular Screening: Individuals over the age of 60 are advised to undergo regular blood counts and kidney function tests for early detection.

· Scientific Mindset: MM is increasingly treated as a "chronic disease" that can be controlled long-term, with the ultimate goal of a total cure.

Expert Review: Professor Du Juan Department of Hematology, Renji Hospital

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