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Introduction
Multiple myeloma (MM) is a heterogeneous genetic disease characterized by the presence of abnormal clonal plasma cells in the bone marrow [1, 2]. It causes destructive bone damage, kidney damage, anemia, and hypercalcemia, making it the second most common hematologic malignancy, accounting for approximately 13% of all blood cancers [3]. With the advent of treatments such as immunomodulatory drugs (IMIDs), proteasome inhibitors (PIs), histone deacetylase inhibitors, chimeric antigen receptor (CAR)-T cell therapy, and autologous stem cell transplantation (ASCT), the survival rates of patients with MM have markedly improved. In addition, with the application of CD38 monoclonal antibody (Daratumumab, Isatuximab), the survival of MM patients has also been greatly improved, bringing a new breakthrough for the treatment of MM. This has led to a significant change in the paradigm of MM treatment, further improving the clinical outcomes of patients with MM [4, 5].
The initial treatment approach of newly diagnosed MM patients deemed suitable for transplantation is usually followed by two (2) to four (4) cycles of induction therapy followed by ASCT [6]. For patients deemed unsuitable for transplantation, induction therapy is also given first; however, the duration of treatment is usually prolonged [7]. Despite tremendous progress in incorporating novel agents such as bortezomib, thalidomide, and lenalidomide into induction regimens, the majority of patients still experience disease progression or relapse, ultimately leading to death [8, 9]. Therefore, the pursuit of enhanced and more efficacious therapeutic regimens to manage disease progression in MM patients after initial treatment has great significance in improving the survival rates of MM patients. The treatment of MM is gradually shifting to maintenance and consolidation therapy, which has demonstrated superior outcomes compared to fixed-duration treatment followed by a remission period [9]. Consolidation therapy entails a short regimen aimed at deepening the response to initial therapy, commonly used in the transplant setting. Its primary goal is to further enhance the response achieved through induction therapy and HDT/ASCT [10, 11]. Maintenance therapy is typically extended for a prolonged duration, often using a single agent, and is designed to prolong both progression-free survival (PFS) and overall survival (OS) by maintaining disease quiescence through continued treatment [12].
Currently, PIs are commonly used in standard induction protocols for MM. PIs function by inhibiting the proteasome’s ability to...