Advances in the treatment of multiple myeloma

Conventional chemotherapy for multiple myeloma results in low complete response rates, and disease progression usually occurs within a couple of years. High-dose chemotherapy with autotransplantation, which has been shown to result in encouraging complete remission rates over several years in phase II studies, was recently shown in a randomized study to be superior to conventional therapy. Eventual tumor recurrence is a problem after autografting, and the development of novel maintenance chemotherapy or immunotherapy strategies is necessary to eliminate minimal residual disease. Although allogeneic transplantation cures a small proportion of patients, high transplant-related mortality and relapse rates hamper survival. Development of novel conditioning regimens and means to harness the graft-versus-myeloma effect without the associated morbidity of graft-versus-host disease are necessary to improve success rates. Supportive therapy, mainly bisphosphonates to delay progression of bone disease and improve bone density and erythropoietin to improve hemoglobin levels, also plays an important role in the overall management. This article reviews therapeutic advances in multiple myeloma from the 1996 literature.