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Current Opinion in Hematology:
Hematologic malignancies

Recent advances in multiple myeloma

Sjak-Shie, Nelida N. MD, PhD*; Vescio, Robert A. MD*†; Berenson, James R. MD*†

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Abstract

Multiple myeloma is the second most common hematologic malignancy, with approximately 15,000 new cases each year in the United States. Our understanding of the pathophysiology underlying myeloma continues to expand, but the cause of this plasma cell dyscrasia remains unclear. Though controversy remains regarding a possible viral cause of myeloma, evidence suggesting a role for the human herpesvirus-8 is mounting. The roles of cytogenetic abnormalities as well as aberrant angiogenesis and cytokine expression in the etiology of myeloma continue to be explored and may lead to future therapeutic strategies. Transplantation in myeloma is rarely curative but offers clinical benefit not only for young but possibly for older myeloma patients as well. Newer bisphosphonates may offer greater ease of administration, improved efficacy, and possibly even enhanced antitumor effect. Finally, thalidomide offers significant clinical benefit to patients with myeloma previously refractory to multiple agents, and its role in early stages of the disease is under investigation.

Abbreviations:FISH fluorescence in situ hybridization, HHV-8 human herpesvirus-8, MGUS monoclonal gammopathy of undetermined significance

Multiple myeloma accounts for approximately one tenth of all hematologic malignancies, and its incidence is rising with the aging of our society. Though we continue to add to our understanding of the pathophysiology underlying myeloma, the cause of this plasma cell dyscrasia remains unclear. Though controversy remains regarding a possible viral cause of myeloma, evidence suggesting a role for human herpesvirus-8 (HHV-8) is mounting. The roles of cytogenetic abnormalities as well as aberrant angiogenesis and cytokine expression in the development of myeloma are better understood and may lead to the development of novel therapeutic strategies. Clearly novel therapeutic approaches are needed because the median survival of patients with myeloma remains approximately 3 years. Transplantation in myeloma is rarely curative but offers clinical benefit not only for young but possibly for older myeloma patients as well. Bisphosphonates have become part of the standard of care for bone disease and hypercalcemia in myeloma, but newer analogues may offer greater ease of administration, improved efficacy, and possibly even enhanced antitumor effect. Finally, thalidomide offers significant clinical benefit to patients with myeloma previously refractory to multiple agents, and its role in early stages of the disease is under investigation.

© 2000 Lippincott Williams & Wilkins, Inc.

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