The Challenging Approach to Multiple Myeloma: From Disease Diagnosis and Monitoring to Complications Management

Simple Summary Multiple myeloma (MM) represents the second most common hematological malignancy, but its diagnosis can be significantly delayed since symptoms are not specific and, mainly in the older population, alternate diagnoses can mimic MM. Bone marrow biopsy (evaluating the amount of proliferating myeloma cells) remains an essential procedure, but several imaging methods such as whole-body low-dose computed tomography, positron emission tomography or whole-body magnetic resonance have become crucial for the diagnosis and staging of MM, and are also taking on a prognostic role. MM is a clinically and biologically heterogeneous disease; therefore, with the aim to identify patients with different outcomes, some risk models such as ISS, R-ISS or R2-ISS have been proposed over time. However, the most recent attempts have been to establish individualized patient risk, integrating clinical, genomic and therapeutic data in order to personalize treatment and avoid overtreatment and toxicities.Abstract The outcome of multiple myeloma (MM) has significantly improved in the last few decades due to several factors such as new biological discoveries allowing to better stratify disease risk, development of more effective therapies and better management of side effects related to them. However, handling all these aspects requires an interdisciplinary approach involving multiple knowledge and collaboration of different specialists. The hematologist, faced with a patient with MM, must not only choose a treatment according to patient and disease characteristics but must also know when therapy needs to be started and how to monitor it during and after treatment. Moreover, he must deal not only with organ issues related to MM such as bone disease, renal failure or neurological disease but also with adverse events, often very serious, related to novel therapies, particularly new generation immunotherapies such as CAR T cell therapy and bispecific antibodies. In this review, we provide an overview on the newer MM diagnostic and monitoring strategies and on the main side effects of MM therapies, focusing on adverse events occurring during treatment with CAR T cells and bispecific antibodies.