LAUSR

The introduction of the proteasome inhibitor (PI) bortezomib (V) and immunomodulatory drugs (IMiDs) thalidomide (T) and lenalidomide (R/Revlimide) first in salvage, later in front-line multiple myeloma (MM) regimens has dramatically improved overall survival rates from 3–4 to ≥ 8 years, especially in standard-risk patients. Nevertheless, MM relapses in almost all patients, with the duration of subsequent responses decreasing with each line of therapy due to the emergence of resistant clones. Continuous treatment advances to further improve patient outcome are therefore needed. Excitingly, the armamentarium for salvage therapies has been expanded significantly during the past 5 years, now also including next-generation proteasome inhibitors carfilzomib (K) and ixazomib (I), next-generation IMiD pomalidomide (P), as well as first-in-class monoclonal antibodies elotuzumab (Elo) and daratumumab (Dara), and the HDAC inhibitor panobinostat. With several promising additional novel agents in the preclinical and early clinical pipeline, current treatment options in relapsed/refractory MM are anticipated to even further expand in the near future. This editorial summarizes and cautiously interprets updated analyses of recent clinical trials; moreover it proposes potential algorithms for salvage treatment in MM patients.