Advances in the Biology and Treatment of Multiple Myeloma

Multiple myeloma is the second most common hematologic malignancy, with approximately 15,000 new cases each year in the United States. Our understanding of the pathophysiology underlying myeloma continues to expand, but the etiology of this plasma-cell dyscrasia remains unclear. Although controversy remains regarding a possible viral etiology of myeloma, evidence suggesting a role for the human herpesvirus-8 (HHV-8) is mounting. The roles of cytogenetic abnormalities, as well as aberrant angiogenesis and cytokine expression in the etiology of myeloma continue to be explored, and may lead to future therapeutic strategies. Transplantation in myeloma is rarely curative, but offers clinical benefit for young and possibly older myeloma patients as well. Newer bisphosphonates may offer greater ease of administration, improved efficacy, and possibly even enhanced anti-tumor effect. Finally, thalidomide and other new agents offer new therapeutic alternatives to myeloma patients who were previously refractory to multiple agents.