Unique Toxicities of Novel Myeloma Therapies: Focus on Belantamab Mafodotin, Talquetamab, and Selinexor

Recent survival improvements in patients with multiple myeloma are attributable largely to the introduction of three main drug classes, immunomodulatory drugs (IMIDs), proteasome inhibitors, and anti-CD38 monoclonal antibodies. However, the majority of patients will inevitably develop resistance to all three drug classes, and survival in this setting has been historically poor. Several novel therapeutic classes exploiting new mechanisms of action (e.g., chimeric antigen receptor (CAR)-T cell therapy, bispecific antibodies, antibody-drug conjugates (ADC), and selective inhibitors of nuclear export) have shown high levels of activity in relapsed myeloma and promise to transform the treatment landscape. However, these therapies have been associated with distinct toxicity profiles, with adverse effects that are uncommonly observed with conventional antimyeloma therapies. Given improvements in long-term disease control and survival with current therapies, treatment-related toxicity represents an increasingly important health burden in patients with myeloma, and the development of effective toxicity management strategies is required to minimize complications and ensure preserved quality of life.