Medical Oncologist
Blood Cancer Targeted Therapy
Targeted Therapy for — Multiple Myeloma
Multiple myeloma is now treated with combinations of drugs that target the biology of the cancer cell directly. Your oncologist tests your bone marrow for specific chromosomal changes and matches your regimen to those results.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Genetics guide the regimen — FISH testing of your bone marrow identifies chromosomal changes that affect which drugs are most likely to help.
- Most people receive three drugs — NCCN and ASCO guidance recommends triple-drug combinations as standard for most newly diagnosed patients.
- Day care, not hospital admission — Most targeted myeloma treatments are given as day care infusions or oral tablets, without overnight stays.
- Myeloma is managed over time — The goal is sustained control of the disease. Regimens change when the cancer evolves, and there are usually further options available.
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Targeted therapy is central to myeloma treatment today. Your oncologist tests your bone marrow for chromosomal changes — particularly del(17p), t(4;14), and t(11;14) — then matches your regimen to those results. Most newly diagnosed patients receive a combination of a proteasome inhibitor, an immunomodulatory drug, and a monoclonal antibody, per NCCN and ASCO guidance.
What does targeted therapy mean in multiple myeloma?
Targeted therapy uses drugs designed to act on specific proteins or pathways that myeloma cells depend on to grow and survive.
This is different from traditional chemotherapy, which damages all rapidly dividing cells. Targeted drugs are more selective, though they still cause side effects.
In myeloma, your oncologist does not choose one drug — they choose a combination from different classes, each working through a different mechanism. Knowing the chromosomal profile of your myeloma is what makes that choice precise.
Which genetic markers does your oncologist test before choosing your treatment?
- del(17p)Deletion of part of chromosome 17, where the TP53 gene sits. A high-risk marker that shapes the intensity and choice of regimen.
- t(4;14)Translocation between chromosomes 4 and 14. Linked to higher-risk disease and specific treatment considerations per NCCN.
- t(14;16)Translocation associated with more aggressive disease behaviour. Classified as high-risk by ESMO and NCCN.
- t(11;14)Translocation associated with elevated BCL-2 expression and potential sensitivity to a class of BCL-2-targeting drugs in a proportion of patients.
- Gain of 1q21Extra copies of part of chromosome 1. Recognised as a high-risk cytogenetic finding by NCCN and ESMO, particularly when multiple copies are present.
- HyperdiploidyExtra chromosomes overall. Generally associated with standard-risk disease and a more favourable disease course compared with the markers above.
What drug classes are used and what do they target?
Proteasome inhibitors block the cell's internal protein-disposal system. Myeloma cells accumulate toxic, damaged proteins until they die. This class is used in nearly all standard myeloma regimens.
Immunomodulatory drugs — often called IMiDs — work by binding to a protein called cereblon inside the cancer cell. This triggers destruction of proteins the myeloma cell needs to survive, and also activates an immune response against the cancer.
Anti-CD38 monoclonal antibodies attach to a protein called CD38, which myeloma cells carry at high levels. Once attached, the antibody flags the cancer cell for destruction by the immune system.
BCMA-targeted agents — including antibody-drug conjugates and bispecific antibodies — target B-cell maturation antigen, a protein expressed abundantly on myeloma cells. These are most often used when earlier treatment has stopped working.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Mohammed Imran
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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What regimen will you actually receive?
For most newly diagnosed patients, NCCN and ASCO guidelines recommend a three-drug combination — one drug from each of the first three classes above.
If your FISH results show del(17p) or t(4;14), your oncologist may adjust the combination or treatment intensity. High-risk cytogenetics do not eliminate options — they determine how the regimen is constructed.
Treatment is given in cycles. After initial treatment, a maintenance phase — typically a single drug continued at lower intensity — aims to keep the disease controlled for as long as possible.
Whether you are a candidate for autologous stem cell transplant is a separate decision, based on your age and overall fitness, and is assessed alongside your targeted therapy plan.
Did you know?
Triple-drug regimens combining a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 monoclonal antibody are now the standard first-line recommendation for most newly diagnosed myeloma patients, according to NCCN, ASCO, and ESMO.
This shift — from two-drug to three-drug combinations as the starting point — has taken place within the last decade and represents one of the most significant changes in how myeloma is managed from diagnosis.
Source: NCCN Guidelines for Multiple Myeloma; ESMO Clinical Practice Guidelines for Multiple Myeloma
Questions families ask about myeloma targeted therapy
What does it mean if my FISH test shows del(17p)?
Del(17p) is the deletion of part of chromosome 17, where the TP53 tumour-suppressor gene sits. NCCN classifies it as a high-risk cytogenetic finding. It does not mean treatment will not work — it means your oncologist will choose a regimen and an intensity designed for higher-risk disease. Maintenance therapy after initial treatment may also be planned differently from the standard approach. Ask your oncologist specifically how del(17p) is shaping the options being offered to you.
Why do I need three drugs instead of one?
Myeloma cells find ways to survive single-drug treatment by using alternative survival pathways. Three drugs from three different classes block multiple pathways at once, making it harder for the cancer to adapt. Clinical evidence reviewed by NCCN and ASCO consistently shows that triple combinations produce deeper and more sustained responses than two-drug combinations for most patients. This is why three-drug regimens are now the starting point for most people, not a step reserved for severe or refractory disease.
Will I need a stem cell transplant alongside targeted therapy?
Autologous stem cell transplant — where your own stem cells are collected, stored, and returned after high-dose treatment — remains an option for patients who are fit enough, typically assessed on the basis of age and general health. It is considered separately from your targeted therapy regimen, not as a replacement for it. Some patients proceed to transplant after completing initial targeted therapy; others are managed on targeted therapy alone. Your oncologist will explain both pathways and the evidence behind each one for your specific situation.
What happens if the myeloma comes back?
Relapse is common in myeloma, and the disease is generally managed over a long period with successive lines of treatment. When a regimen stops working, your oncologist will usually change one or more drug classes, or introduce drugs you have not yet received. BCMA-targeted agents, XPO1 inhibitors, and newer bispecific antibodies are among the options used in the relapsed or refractory setting, per NCCN and ESMO guidance. Relapse does not mean the disease is no longer treatable — it means the treatment plan changes to match how the disease has evolved.
Can I receive this treatment at CION without being admitted to hospital?
Most myeloma targeted therapies — including intravenous monoclonal antibodies and subcutaneous proteasome inhibitors — are given as day care at CION centres, without overnight hospital admission. Oral immunomodulatory drugs are taken at home between clinic visits. Infusions that require closer observation on the first dose may take a full day initially; subsequent cycles are often shorter. Your care team will explain the schedule for your specific regimen before treatment begins, so you can plan around it.
Should I tell my oncologist about supplements or traditional medicines I am taking?
Yes, and this matters more than it might seem. Some herbal preparations and traditional medicines interact with myeloma drugs — particularly immunomodulatory drugs, which affect multiple biological pathways. Your oncologist is not asking you to abandon a practice that is meaningful to you. They are asking so they can review it safely alongside your treatment and flag any known interactions. Please bring a complete list of everything you are taking — prescribed or not — to every appointment. If you are unsure whether something is relevant, include it anyway.
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Common questions
Frequently asked questions
Is multiple myeloma curable with targeted therapy?
Myeloma is not considered curable for most patients with current treatments, and any claim to the contrary should be questioned. What targeted therapy aims to achieve is deep, sustained remission — a state where the disease is controlled and you can live well. ASCO and ESMO describe treatment goals in myeloma in terms of response depth and duration, not cure. Some patients remain in remission for extended periods. Outcomes vary by cytogenetics, fitness, and how the disease responds to initial treatment — your oncologist can speak to what is realistic for your specific situation.
What is the difference between a proteasome inhibitor and an IMiD?
They work through completely different mechanisms. Proteasome inhibitors block the cell's internal waste-disposal system, causing myeloma cells to die from an accumulation of damaged proteins. Immunomodulatory drugs — IMiDs — bind to a protein called cereblon inside the cancer cell, triggering destruction of proteins the cell needs to survive, and they also stimulate an immune response against the cancer. Both are effective against myeloma through different routes, which is why they are used together in combination rather than as alternatives to each other.
How is t(11;14) different from other translocations in myeloma?
The t(11;14) translocation is associated with elevated expression of BCL-2, a protein that helps myeloma cells resist cell death. This creates a potential vulnerability: a class of drugs called BCL-2 inhibitors has shown activity in myeloma carrying this translocation in a proportion of patients. Unlike del(17p) or t(4;14), t(11;14) is not classified as a high-risk marker by NCCN — it is more informative about a specific biological pathway than a direct indicator of a worse prognosis. Ask your oncologist how your translocation profile is shaping the options being considered.
How long does myeloma targeted therapy last?
Initial treatment typically runs for a fixed number of cycles over several months, followed by a maintenance phase that may continue for years. There is no universal endpoint. Maintenance therapy is generally continued as long as it is controlling the disease and you are tolerating it. NCCN and ASCO guidance supports long-term maintenance for most patients, because stopping early is associated with earlier relapse. Your oncologist will review the plan at each assessment and explain how long each phase is expected to last based on your response.
My family member was diagnosed in another city. Can we continue treatment at CION?
Yes. Continuing myeloma treatment at a different centre is common, and your oncologist can receive your records and pick up from where your previous team left off. Bring all investigation reports to the first appointment — including your FISH results, bone marrow biopsy report, and previous treatment records including drug names and cycle details. If any testing is incomplete or unavailable, the team will arrange what is needed before continuing treatment. Transfer of care does not require starting from the beginning.
What tests are done to check whether the treatment is working?
Response to myeloma treatment is assessed primarily through blood tests — serum protein electrophoresis, immunofixation, and the serum free light chain assay — rather than imaging alone. These measure the amount of abnormal protein the myeloma cells are producing. PET-CT is used when bone disease needs to be assessed or when blood and bone marrow results are inconclusive. Bone marrow biopsy is repeated at key points to assess how deeply the disease has responded. Your oncologist will explain the assessment schedule and what the results mean at each review.