Considerations in the management of myeloma

Multiple myeloma remains an incurable cancer. In recent years, progress in different drug classes has improved outcomes, but management has become mor e complicated. Areas such as prognostic classification, the increased use o f high-dose chemotherapy with autologous stem-cell rescue, and a wider arra y of ancillary drugs must be integrated into recommendations for a consolid ated treatment plan. Estimating prognosis is dependent on both clinical fea tures and a growing list of laboratory tests. Autologous transplantation ha s been applied to an increasing proportion of patients, at different points in the disease process. Besides the age cut-off issue, there are still sig nificant treatment choices to be made within the transplant technique. Newe r drugs, most recently, thalidomide (Thalomid), may offer benefits independ ent of conventional cytotoxic drugs or steroids. Use of ancillary drugs, su ch as diphosphonates, interferon, P-glycoprotein blockers, antibiotics, and growth factors, are also discussed. For the future, immunotherapy in the p osttransplant setting appears promising. Ultimately, basic research must id entify intracellular targets for the development of specific new-generation drugs.