Multiple myeloma: An update on biology and treatment

Recently, several advances have been made in understanding the pathogenesis of multiple myeloma. Increasing evidence favours a pre-switched, but somat ically mutated B-cell as myeloma stem cell to give rise to the malignant cl one. Deletions of the p53-gene, partial or total loss of chromosome 13 and rearrangements of band 14q32 and 11q13 are frequently found in multiple mye loma, and were shown to harbour prognostic significance. Presence or absenc e of distinct chromosomal aberrations may guide selection of treatment stra tegies in the future. Although melphalan/prednisolone remains the standard of myeloma treatment i n elderly patients, significant improvement has been achieved in antimyelom a and in supportive therapy. High dose therapy with autologous stem cell tr ansplantation enhances survival in younger patients and several trials are ongoing to substantiate these results. The effect of interferon maintenance treatment on overall survival is significant in metaanalysis, although the gain achieved is limited. Newer treatment strategies - targeting the molec ular level - have just entered clinical trials, and may further improve out come of myeloma patients.