THERAPEUTIC ADVANCES IN MULTIPLE MYELOMA TREATMENT: THE ROLE OF DARATUMUMAB AND MRD IN PERSONALIZED THERAPY

Abstract

This article aimed to describe the main existing therapies and their advancements in the treatment of multiple myeloma, comparing efficacy and tolerability, particularly focusing on the use of daratumumab and minimal residual disease (MRD) in personalized therapy. Despite progress with the use of the anti-CD38 antibody (daratumumab), challenges remain—especially among patients with high genetic risk—highlighting the need for further studies to expand therapeutic options and improve both survival and quality of life. On the other hand, studies such as GRIFFIN and MASTER, which included daratumumab, demonstrated that its combination with lenalidomide, bortezomib, carfilzomib, and dexamethasone led to high rates of complete response and MRD negativity, representing a significant advancement in disease management, even for transplant-ineligible patients. MRD is a promising marker that allows for more accurate evaluations of therapeutic efficacy. However, patients with multiple high-risk cytogenetic abnormalities (HRCAs) still face an unfavorable prognosis. In cases of relapse or refractory disease, regimens like D-Vd, Isa-Pd, and KPd have shown effectiveness, even in multi-resistant patients. Quadruple therapy (Dara-KRd) has also proven effective as an alternative to autologous transplant. The review highlights the importance of treatment personalization and the rational use of MRD as a therapeutic guide.