Introduction
TD regimen, death, apoptosis-inducing, cancers
CANCERS, MULTIPLE MYELOMA (MM), TUMOR NECROSIS, SECONDARY, REFRACTORY MULTIPLE MYELOMA, HEMATOLOGICAL MALIGNANCY
Although in the past 20 years, several new drugs have been approved, multiple myeloma (MM) remains an incurable hematological malignancy, and almost all patients eventually become drug-resistant [Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induces apoptosis selectively by activating death receptor 4 or 5 (DR4/5) in a wide range of cancers while sparing normal cells [Aponermin is a recombinant circularly permuted human TRAIL (CPT), by connecting the amino end and the carboxy end of the native TRAIL fragment (amino acid 121–281) with the linker (Gly-Gly-Gly-Gly-Gly) and breaking the TRAIL fragment at the site of amino acid 135 to create new amino and carboxy termini. The primary sequence of the aponermin protein was reordered, while its secondary structure and activity were retained. Aponermin is a more stable homotrimer and has shown a higher affinity for DR4/5, more potent antitumor activity and longer half-life than native TRAIL [In the phase 1b study in patients with relapsed or refractory multiple myeloma (RRMM) [Thalidomide combined with dexamethasone (TD regimen) has been approved for the treatment of MM in 2006. Although TD regimen is no longer widely used in developed countries with the approval of novel drugs, it is still a good option in low- and middle-income countries due to its accessibility and affordability [