Care For Newly Diagnosed Patients Who Are Not Eligible For Transplant The Arrival Of Immunostimulation

While the prognosis of multiple myeloma has been significantly improved by the development of proteasome inhibitors and immunomodulators, the disease remains incurable and the survival time is around five years in patients not eligible for transplantation. The second turning point in the history of myeloma therapies is undoubtedly the arrival of immunotherapy, whose activity notably restores anti-tumor immune functions. The anti-CD38 monoclonal antibodies combine particularly well with immunomodulators: their synergy allows lasting responses and this combination becomes the new benchmark for newly diagnosed patients not eligible for transplantation. If myeloma is in itself associated with a decrease in immune functions (dysfunction of B, T and NK lymphocytes, as well as dendritic cells but also action of regulatory T cells and suppressive myeloid cells), aging also participates in the immune system. - senescence. Therapeutic targeting of the immune system therefore appears to be particularly advantageous in the context of the elderly. A better understanding of the mechanisms of anti-tumor immune dysfunction is necessary to optimize the use of immunotherapy in the arsenal of myeloma drugs.