Patients with multiple myeloma may become resistant to the various types of therapy available.

Major classes of treatment for multiple myeloma:

(1) ant-CD38 monoclonal antibody (daratumumab)

(2) immunomodulatory drugs (lenalidomide, pomalidomide, etc)

(3) protease inhibitors (bortezomib, carfilzomib)


Triple class resistance (TCR) indicates resistance to all 3 of the major classes of therapy.


Clinical features of this group:

(1) high risk disease with poor survival

(2) reduced treatment options

(3) greater risk of side effects from more aggressive treatment

(4) worse quality of life


This group is separate from triple hit myeloma, refers to number of high-risk cytogenetic findings. Many patients with triple hit myeloma probably are also TCR.

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