Recent advances in the treatment of multiple myeloma.

Multiple myeloma, a clonal B-cell malignancy, accounts for 10% of all hematologic cancers. In patients with multiple myeloma, median survival is approximately 30 to 36 months with conventional therapy, but high-dose chemotherapy resulted in better outcomes in a mature randomized trial. Pamidronate and other bisphosponates, used as supportive therapy, effectively reduce the incidence of skeletal events and decrease pain. They also have a role in disease control. Ongoing trials are now addressing such issues as further intensification with tandem transplantations, timing of transplantation, and decrease of malignant cell reinfusion by positive selection. Important laboratory observations have better defined the malignant clone and its interaction with the microenvironment. These observations will be important for the treatment of myeloma in the future.