title: Therapy strategies for multiple myeloma: current status.
abstract: Multiple myeloma (MM) is characterized by infiltration of bone marrow with a clone of neoplastic plasma cells. Impaired hematopoiesis and reduced production of functional immunoglobulins, as well as the induction of pathognomonic osteolytic lesions primarily contribute to the morbidity of patients with MM. Conventional chemotherapy is the treatment of choice for older patients, whereas those under 60 years benefit significantly from high-dose therapy followed by stem-cell rescue. The use of tandem transplantation, developed to further escalate the conditioning dose, has achieved additional improvement in survival. Interferon-alpha and glucocorticoids are effective as maintenance measures in MM but remain controversial because of their associated high costs and considerable toxicity. The resurrection of an old drug, thalidomide, for the therapy of MM and the development of potent immunomodulatory derivatives are highly promising new treatments that target MM cell-host interactions and the bone-marrow microenvironment, as well as the myeloma cell itself. The importance of the use of bisphosphonates for the prevention or amelioration of skeletal complications and hypercalcemia is well established. New generations of bisphosphonates show potent antitumor activity, again emphasising the importance of targeting the microenvironment of the plasma-cell clone.
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D002986:Clinical Trials as Topic; D017322:Clinical Trials, Phase II as Topic; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006131:Growth Inhibitors / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D010087:Oxides / Q000627:therapeutic use; D036102:Peripheral Blood Stem Cell Transplantation; D011480:Protease Inhibitors / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D000276:Adjuvants, Immunologic; D020533:Angiogenesis Inhibitors; D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D001152:Arsenicals; D001897:Boronic Acids; D004164:Diphosphonates; D005938:Glucocorticoids; D006131:Growth Inhibitors; D007166:Immunosuppressive Agents; D010087:Oxides; D011480:Protease Inhibitors; D011719:Pyrazines; D004921:Erythropoietin; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077237:Arsenic Trioxide