Current and Novel Alkylators in Multiple Myeloma

SIMPLE SUMMARY: In this review we have summarized the history, the current use, and the future possibilities of alkylator treatment in multiple myeloma. Alkylators have for decades been part of the standard of care of myeloma treatment, but still new alkylators and new use of old alkylators are making its way into myeloma guidelines of today. ABSTRACT: A large number of novel treatments for myeloma have been developed and approved; however, alkylating drugs continue to be part of standard regimens. Additionally, novel alkylators are currently being developed. We performed a non-systematized literary search for relevant papers and communications at large conferences, as well as exploiting the authors’ knowledge of the field, to review the history, current use and novel concepts around the traditional alkylators cyclophosphamide, bendamustine and melphalan and current data on the newly developed pro-drug melflufen. Even in the era of targeted treatment and personalized medicine, alkylating drugs continue to be part of the standard-of-care in myeloma, and new alkylators are coming to the market.