[Multiple myeloma: a proper selection of the treatment regimen for an individual patient]

The importance of distinguishing accurately between patients with asymptomatic or stable monoclonal gammopathies and those with overt multiple myeloma cannot be overemphasized. Most patients with asymptomatic monoclonal gammopathy will remain stable without treatment, but in some overt multiple myeloma may develop after several to many years of observation. Multiple myeloma is a malignant disease of the bone marrow plasma cells. Most patients die of progressive disease despite chemotherapy. Thus, accurate differentiation between asymptomatic monoclonal gammopathy and multiple myeloma is essential. Given a diagnosis of overt myeloma, how does the physician decide which treatment regimen to use for an individual patient? Based on the risk assessment, age considerations and risk benefit consideration for the patient, the most proper selection of treatment regimen should be done. Until we can identify a group of patients who will survive longer, intensive therapy, including stem cell transfusion, should be done with caution.