Precision medicine, an approach tailored to individual patient characteristics and disease profiles, has become increasingly important in the treatment of multiple myeloma (MM). Conventional MM treatment often yields variable results because the biological and clinical course of MM is heterogeneous.

One of the main strategies in precision medicine for MM is genetic profiling. Certain genetic mutations such as t(4;14), t(14;16) and del(17p) are associated with a higher risk of aggressive disease. In addition, copy number alterations involving the long arm of chromosome 1 (1q) predict worse survival. In addition to cytogenetics, differential gene expression profile (GEP) signatures are independent prognostic factors for both PFS and OS, thus providing an additional method to identify high risk. By identifying these markers early, clinicians can classify patients into risk categories and tailor treatment accordingly. High-risk patients may receive more intensive treatments, while standard-risk patients may benefit from less aggressive regimens that preserve quality of life.

Targeted therapies are another critical component of precision medicine in MM. Unlike conventional chemotherapy, which affects both cancerous and healthy cells, targeted therapies are designed to act specifically on the molecular pathways that drive MM cell growth. Drugs such as proteasome inhibitors, immunomodulatory agents and monoclonal antibodies are designed to attack key mechanisms in MM cells. For example, proteasome inhibitors disrupt protein excretion pathways in cancer cells, leading to cell death, while monoclonal antibodies can mark MM cells for immune destruction. These therapies offer more effective and tolerable treatment options when matched to patients whose disease characteristics are compatible with the drug's mechanism. CAR-T cell therapy and bispecific antibodies are promising options for relapsed/refractory MM and offer significant disease reduction for patients with limited options.

Precision medicine also plays a role in monitoring minimal residual disease (MRD), which refers to the small number of cancer cells that can remain after treatment and potentially cause relapse. Multiparameter flow cytometry (MFC) and next-generation sequencing (NGS) are the most common and standardised methods. Whole body MRI and PET/CT provide better assessment for extramedullary disease. Patients with MRD-negative status generally have better long-term outcomes, so precision medicine approaches can tailor treatment to MRD status, aiming for complete eradication of disease in patients with evidence of remaining cancer cells.

Finally, clinical trials are essential to develop precision medicine in MM. Studies focused on biomarker-driven therapies and novel agents give patients access to cutting-edge treatments that may be more effective for specific disease profiles. As genomic data and biomarker research progress, trials are increasingly focused on matching patients with therapies based on individual molecular characteristics, increasing the likelihood of a favourable outcome.

AI is supporting precision medicine in MM by improving diagnostic accuracy, risk stratification and treatment matching, potentially transforming personalised oncology care. Overall, precision medicine in MM, supported by AI insights, aims to optimise treatment efficacy, promote longer-lasting remission and improve quality of life by tailoring therapies to each patient's unique disease profile.