Review Why Immunotherapy Fails in Multiple Myeloma Luis Gerardo Rodríguez-Lobato 1,2,†, Aina Oliver-Caldés 1,2,† , David F. Moreno 1,2, Carlos Fernández de Larrea 1,2,‡ and Joan Bladé 1,2,*,‡ 1 Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain;
[email protected] (L.G.R.-L.);
[email protected] (A.O.-C.);
[email protected] (D.F.M.);
[email protected] (C.F.d.L.) 2 Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain * Correspondence:
[email protected]; Tel.: +34-93-227-54-28; Fax: +34-93-227-54-84 † These authors contributed equally to this manuscript. ‡ These authors share senior authorship. Abstract: Multiple myeloma remains an incurable disease despite great advances in its therapeutic landscape. Increasing evidence supports the belief that immune dysfunction plays an important role in the disease pathogenesis, progression, and drug resistance. Recent efforts have focused on harnessing the immune system to exert anti-myeloma effects with encouraging outcomes. First-in- class anti-CD38 monoclonal antibody, daratumumab, now forms part of standard treatment regimens in relapsed and refractory settings and is shifting to front-line treatments. However, a non-negligible number of patients will progress and be triple refractory from the first line of treatment. Antibody- drug conjugates, bispecific antibodies, and chimeric antigen receptors (CAR) are being developed in a heavily pretreated setting with outstanding results. Belantamab mafodotin-blmf has already received approval and other anti-B-cell maturation antigen (BCMA) therapies (CARs and bispecific antibodies are expected to be integrated in therapeutic options against myeloma soon.