Immunotherapy in multiple myeloma

Therapeutic approaches in multiple myeloma (MM) are increasingly focused on restoring antitumor immunity. Immunomodulators have a variety of effects on the immune microenvironment, and are frequently incorporated into multidrug regimens. The monoclonal antibodies daratumumab and elotuzumab have been granted accelerated approval for use in the relapsed or refractory setting, and several other antibodies including immune checkpoint inhibitors are currently being evaluated for the treatment of MM. Antimyeloma vaccines have been developed, and may be useful in maintaining remission. The role of allogeneic stem cell transplantation continues to be an area of active research, as reduced intensity conditioning (RIC) regimens have significantly decreased treatment-related complications. Other immunotherapeutic approaches in development include marrow infiltrating lymphocytes, T cell receptor modified T cells (TCRts), and chimeric antigen receptor (CAR) T cells. Here we review the existing data on immunotherapy in MM, and discuss some promising areas of research which may impact the future of myeloma therapy.