Multiple myeloma

Nat Rev Dis Primers. 2017 Jul 20;3:17046. doi: 10.1038/nrdp.2017.46.


Multiple myeloma is a malignancy of terminally differentiated plasma cells, and patients typically present with bone marrow infiltration of clonal plasma cells and monoclonal protein in the serum and/or urine. The diagnosis of multiple myeloma is made when clear end-organ damage attributable to the plasma cell proliferative disorder or when findings that suggest a high likelihood of their development are present. Distinguishing symptomatic multiple myeloma that requires treatment from the precursor stages of monoclonal gammopathy of undetermined significance and smouldering multiple myeloma is important, as observation is the standard for those conditions. Much progress has been made over the past decade in the understanding of disease biology and individualized treatment approaches. Several new classes of drugs, such as proteasome inhibitors and immunomodulatory drugs, have joined the traditional armamentarium (corticosteroids, alkylating agents and anthracyclines) and, along with high-dose therapy and autologous haemopoietic stem cell transplantation, have led to deeper and durable clinical responses. Indeed, an increasing proportion of patients are achieving lasting remissions, raising the possibility of cure for this disease. Success will probably depend on using combinations of effective agents and treating patients in the early stages of disease, such as patients with smouldering multiple myeloma.

Publication types

  • Review

MeSH terms

  • Bone Marrow / pathology*
  • Epigenomics
  • Hematopoietic Stem Cell Transplantation / methods
  • Humans
  • Immunomodulation
  • Incidence
  • Monoclonal Gammopathy of Undetermined Significance / diagnosis
  • Multiple Myeloma / diagnosis*
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / epidemiology
  • Multiple Myeloma / pathology
  • Myeloma Proteins / analysis
  • Myeloma Proteins / urine
  • Paraproteinemias / blood*
  • Paraproteinemias / pathology
  • Plasma Cells / pathology*
  • Prevalence
  • Proteasome Inhibitors / therapeutic use
  • Risk Factors
  • Transplantation, Autologous / methods
  • Tumor Microenvironment
  • United States / epidemiology


  • Myeloma Proteins
  • Proteasome Inhibitors
  • multiple myeloma M-proteins