During the last decade, thalidomide, lenalidomide and bortezomib have significantly improved the outcome for patients with multiple myeloma. Although still frequently referred to as ‘novel agents’, a newer generation of more potent proteasome inhibitors and immunomodulatory drugs are expected to enter the myeloma clinic in the near future. New proteasome inhibitors like carfilzomib have shown unprecedented anti-myeloma activity, particularly when combined with lenalidomide and dexamethasone. Other proteasome inhibitors under development will be more patient-friendly by becoming orally available. In the class of immunomodulatory drugs, it is expected that pomalidomide will be registered in the near future for refractory myeloma patients, based on convincing phase III data. Finally, after many years of research, myeloma also has its monoclonal antibodies. Daratumumab and elotuzumab are evaluated in several clinical studies. All these new agents will not replace the current, yet not old, anti-myeloma drugs. The major challenge will become to prove that optimal drug sequencing or combination, guided by science and clinical experience, will continue to prolong the life expectancy of patients with multiple myeloma.

(BELG J HEMATOL 2014;5(2):55–9)