Myeloma

Abstract

Summary Multiple myeloma is a monoclonal gammopathy characterized by bone marrow infiltration by plasma cells or a biopsy‐proven plasmacytoma, monoclonal protein in serum and/or urine, and evidence of end‐organ damage (CRAB): hypercalcaemia, Renal impairment, Anaemia or Bone lesions. It accounts for 1% of all cancers and 10% of all haematological malignancies. Although recent therapeutic advances have increased the median survival from 3 to >6 years, multiple myeloma remains incurable for most patients. Several prognostic factors have been identified, with the most important being age, cytogenetics and ISS score. Treatment is mostly adapted to age: patients under the age of 65 years receive induction with novel agents plus autologous stem cell transplantation (ASCT) followed or not by consolidation/maintenance, while patients over the age of 65 years or who are unfit to tolerate ASCT usually receive proteasome inhibitors or immunomodulatory drugs in combination with alkylating agents and corticosteroids. Treatment at relapse should be individualized according to the patient's characteristics and previous treatments.