Multiple myeloma (MM) is a malignant haematologic tumour originating from bone marrow plasma cells, characterised by the abnormal proliferation of monoclonal plasma cells, invasion of the bone marrow, and resulting end-organ damage, with continuous clinical progression. Although standardised treatment regimens and the application of novel cellular immunotherapies have helped control disease progression, the risks of drug resistance and relapse remain, and a complete cure is currently not achievable. mRNA cancer vaccines aim to target personalized neoantigens, inducing strong and specific anti-tumour immune responses, and have garnered widespread attention for their tremendous potential in cancer prevention and treatment. Compared to traditional cancer vaccine platforms, mRNA cancer vaccines offer unique advantages such as high safety, strong immunogenicity, personalized targeted immunotherapy, shorter development cycles, and lower costs, making them a revolutionary tool for achieving the goals of precision medicine. Given the unique advantages of MM, such as antigen lineage specificity, pathological mechanism and therapeutic needs alignment, clear safety profile and treatment endpoints, clinical window, and compatibility with multi-strategy combination therapies, we believe that exploring the use of mRNA cancer vaccines for the treatment of MM is both necessary and promising. In this review, we aimed to summarize the progress of immunotherapy for MM and the current application status of various antigens and vaccines. On this basis, we analysed the specificity and feasibility of mRNA cancer vaccines in MM and proposed strategies for their clinical management and optimisation. We believe that mRNA cancer vaccines have the potential to redefine the treatment paradigm for MM, offering new solutions for patients with refractory and relapsed disease.
