Treatment of newly diagnosed multiple myeloma

The past decade has witnessed a revolution in the treatment of multiple myeloma as a result of introduction of several new effective drugs, which in conjunction with increased use of autologous stem cell transplantation and improved supportive care strategies have resulted in significantly improved survival outcomes for these patients. The survival of patients with myeloma has more than doubled in the past decade, a success story unparalleled by any other cancer. In addition to the improved armamentarium of therapeutic options, there has been a better understanding of the basic disease biology as well as the heterogeneity seen in the disease, in particular the genetic heterogeneity. This has led to development of risk stratifications systems that is increasingly allowing us to individualize the therapy of patients with multiple myeloma. The general approach to treatment of patients with myeloma can be grouped into seven discrete steps as shown in Table 8.1. A systematic approach to the treatment allows us to judiciously use the available therapeutic options allowing the best possible outcomes for these patients.