The Drug Resistance Mechanism and Overcoming Strategies of Immunotherapy for Multiple Myeloma: A Comprehensive Review

Immunotherapy for multiple myeloma (MM) has emerged as a significant breakthrough in the treatment of the disease, despite significantly improving remission rates in patients with relapsed or refractory MM (R/R MM), but still faces challenges such as drug resistance and toxic side effects. Characteristic changes in the immune microenvironment are the main cause of resistance, including T-cell exhaustion, inhibitory factors secreted by bone marrow stromal cells, abnormal expression of immune checkpoints, and tumor antigen escape, etc. Countermeasures include combined targeted therapy, epigenetic regulation, novel immunotherapies, etc. In the future, single-cell technology will be needed to analyze the heterogeneity of resistance. Develop dynamic monitoring markers and formulate individualized regimens. This article reviews the mechanisms of resistance and strategies for overcoming immunotherapy in multiple myeloma, aiming to analyze the key influencing factors and potential therapeutic targets and provide relevant ideas for overcoming immunotherapy resistance.