Management of multiple myeloma today

Multiple myeloma is almost invariably fatal despite a wide variety of chemotherapeutic and supportive treatment options. There are several unresolved problems with existing approaches, including the specific indications for treatment; the optimal combination of agents and doses; and the type, frequency, and timing of high-dose therapy and stem-cell transplantation. High-dose chemotherapy followed by stem-cell transplantation produces higher remission rates, but patients rarely, if ever, are cured by a single regimen. Allogeneic hematopoietic stem-cell transplantations offer a potential graft-versus-myeloma (GVM) effect. Researchers are focusing efforts on improving the safety of transplant procedures, increasing response rates to ablative therapy, and testing novel posttransplant options to improve outcomes. The newly devised National Comprehensive Cancer Network (NCCN) guidelines for treating multiple myeloma are also discussed.