Multiple myeloma is the second most common hematological malignancy.
In almost all cases of myeloma, there is a preceding monoclonal gammopathy of undetermined significance phase.
Diagnosis of multiple myeloma requires demonstration of monoclonal proteins or clonal plasma cells, with symptomatic manifestation.
Mainstay of multiple myeloma treatment remains high-dose therapy with stem cell transplantation. Therefore, the first therapeutic decision point is whether the patient is a transplant candidate.
Over the last decade, three novel agents, thalidomide, lenalidomide, and bortezomib have been approved by the US Food and Drug Administration (FDA) for treatment of multiple myeloma.
The use of novel agents prior to transplantation and as maintenance therapy has greatly improved outcome of myeloma patients. Similarly, for non–transplant-eligible patients, the incorporation of novel agents into their treatments has greatly improved survival.
Radiation therapy is useful in treating symptomatic bone disease and plasmacytomas.