[Advances in the pathogenesis, biology, and management of multiple myeloma]

There have been several advances in our understanding and management of multiple myeloma (MM). Firstly, somatic mutations without intraclonal variation have been detected in Ig genes of malignant plasma cells, indicating that the major oncogenic events yielding continuous proliferation of the myeloma stem cell occur in a cell selected by contact with antigen in the lymphoid follicles. Secondly, interleukin-6 supplied by autocrine and paracrine secretion has been identified as a major cytokine for the emergence of the tumor clone. Thirdly, myeloablative chemoradiotherapy with autologous peripheral blood stem cell rescue has been shown to induce complete remission and to improve prognosis, although disappointingly few patients benefit from it. An improved strategy, such as anti IL-6 and/or anti IL-6R administration with biological therapy directed to suppress the myeloma cell growth is necessary as rational therapy.