©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Advancing multiple myeloma therapy: A systematic analysis of corticosteroids and monoclonal antibodies as dual therapeutic agents
Farah Alam, Huma Siddiqui, Arpna Nihal, Madiha Andleeb, Amna Qamar Uz Zaman, Mehwish Imam Khushk, Fatima Hussain, Rahul Rai, Fasiha Bakhtawar Fatima, Danaish Kumar, Syed Ali Farhan Abbas Rizvi, Shafaq Jabeen, Inshal Jawed, Umair Qadir, Mohammad Ali Zakeri
Farah Alam, Inshal Jawed, Umair Qadir, Department of Medicine, Dow University of Health Sciences, Karachi 75350, Sindh, Pakistan
Huma Siddiqui, Department of Pathology, Aga Khan University Hospital, Karachi 75300, Sindh, Pakistan
Arpna Nihal, Department of Haematology, Sindh Blood Transfusion, Karachi 75300, Sindh, Pakistan
Madiha Andleeb, Department of Pathology, Indus Hospital and Health Network, Karachi 75300, Sindh, Pakistan
Amna Qamar Uz Zaman, Fatima Hussain, Department of Haematology, Dr Ziauddin University and Hospital, Karachi 75300, Sindh, Pakistan
Mehwish Imam Khushk, Rahul Rai, Department of Haematology, Liaquat University of Medical and Health Sciences, Hyderabad 76090, Sindh, Pakistan
Fasiha Bakhtawar Fatima, Department of Medicine, DOW Medical College, Karachi 74200, Sindh, Pakistan
Danaish Kumar, Shafaq Jabeen, Department of Medicine, Karachi Dental and Medical College, Karachi 75600, Sindh, Pakistan
Syed Ali Farhan Abbas Rizvi, Department of Medicine, Jinnah Medical and Dental College, Karachi 74800, Sindh, Pakistan
Mohammad Ali Zakeri, Department of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan 7718796755, Kermān, Iran
Author contributions: Alam F, Siddiqui H, Nihal A, Andleeb M, Zaman AQU, Khushk MI, Hussain F, Rai R, Fasiha, Kumar D, Ali F, Jabeen S, Jawed I, Qadir U, and Zakeri MA designed the research study; Alam F, Nihal A, Andleeb M, Zaman AQU, Hussain F, Rai R, Fasiha, Kumar D, Ali F, Jabeen S, Jawed I, and Qadir U performed the literature search and data extraction; Siddiqui H, Khushk MI, and Zakeri MA contributed to study selection and quality assessment; Alam F, Siddiqui H, Nihal A, Jawed I, and Zakeri MA analyzed the data and wrote the manuscript; Andleeb M, Zaman AQU, Khushk MI, Hussain F, Rai R, Fasiha, Kumar D, Ali F, Jabeen S, and Qadir U contributed to manuscript revision and editing. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflicts of interest or financial interests related to the content of this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Inshal Jawed, Chief Physician, Senior Researcher, Department of Medicine, Dow University of Health Sciences, Baba-e-urdu Karachi, Karachi 75350, Sindh, Pakistan.
inshaljwd@gmail.com
Received: April 2, 2025
Revised: May 22, 2025
Accepted: July 29, 2025
Published online: March 20, 2026
Processing time: 317 Days and 22.5 Hours
BACKGROUND
Multiple myeloma (MM) is an incurable hematopoietic malignancy defined by the bone marrow's clonal expansion of neoplastic plasma cells. Corticosteroids and monoclonal antibodies (mAbs) have been approved for the treatment of MM over the past 20 years and are now key components of treatment regimens, improving clinical outcomes. Corticosteroids (dexamethasone and prednisone) are frequently used in combination with other agents [proteasome inhibitors and immunomodulatory drugs (IMiDs)], while mAbs (daratumumab, elotuzumab, and isatuximab) have transformed treatment paradigms, particularly for relapsed/refractory cases.
AIM
To evaluate the impact of corticosteroids and mAbs on the treatment of MM.
METHODS
This systematic review integrates results from randomized controlled trials and cohort studies published from 2003 to 2024. This resulted in the identification 26 articles assessing the role of corticosteroids and mAbs in various treatment settings: Newly diagnosed, relapsed, and refractory MM. Seventeen studies were included in the systematic review.
RESULTS
We show that corticosteroid-based combination regimens are critical for achieving rapid tumour regression and increasing overall survival (OS) when combined with proteasome inhibitors (bortezomib or carfilzomib). Moreover, mAb therapy, particularly with daratumumab, has also led to significant benefits, enhancing progression-free survival and OS when added to first- and later-line therapy. All IMiDs and proteasome inhibitors offer activity when combined with daratumumab, with the efficacy being better with daratumumab, even in higher-risk patients. However, treatment of high-risk MM, including those with extramedullary disease and patients with adverse genetics, still poses challenges.
CONCLUSION
While great strides have been made in the treatment, much remains to be learned about long-term safety, efficacy, and potential resistance mechanisms to these treatments.
Core Tip: Corticosteroids and monoclonal antibodies (mAbs) deliver extensive therapeutic value to patients with multiple myeloma (MM) by providing survival improvements, particularly for people with relapsed or refractory disease. The essential medication dexamethasone, alongside other corticosteroids, has long proved beneficial in treatment regimens because it decreases tumor size and works better with other treatments. The development of daratumumab and other mAbs introduced specific tumor cell antigen targeting, producing significant study results for high-risk patients. Modern advancements in cancer therapy have produced promising results, although ongoing research aims to address corticosteroid-related long-term effects, prevent infusion responses in mAbs, and decrease their costly nature.
