Recent advances in the management of multiple myeloma.

ABSTRACT

Multiple myeloma is a disease of malignant plasma cells in the bone marrow. Interaction of malignant plasma cells with the bone marrow microenvironment plays a key role in the pathogenesis of the disease. The introduction of two new classes of molecules, namely immunomodulators (e.g. thalidomide, lenalidomide), and proteasome inhibitors (e.g. bortezomib) has led to improvement in the management of myeloma. Induction therapy with these novel drugs in combination with dexamethasone is associated with higher response rates including complete response in one-fourth of patients with bortezomib combinations. Further consolidation with intensive chemotherapy supported by autologous stem cell transplant in young, eligible patients results in complete response in 50%–70% of patients with improved survival. Simplified criteria for staging, uniform response criteria, more sensitive methods for detection of residual disease (immunofixation and free light chain assay), and recognition of potential adverse cytogenetic and genomic abnormalities have further refined the management of patients with myeloma. Along with earlier diagnosis, improved treatment and better management of complications have resulted in longer disease control and survival with a better quality of life.