There have been major advances in myeloma therapeutics in the last decade as novel agents including immunomodulatory agents and proteasome inhibitors have been incorporated into treatment regimens. These changes have improved clinical outcome, and the median survival of intensively treated patients is now between 5 and 9 years.[135,136] Despite these advances, therapy remains noncurative and there is large interpatient variability in outcome. Some patients remain in a durable remission for many years following initial treatment, and with increasingly effective salvage therapies, long-term survival is a realistic prospect. At the other end of the clinical spectrum, a subset of patients have a disease course characterized by rapid relapse with early progression to a refractory disease state. Consequently, there is the potential to improve patient outcomes by basing treatment decisions around this clinical variation. However, in order to carry out this approach, robust biomarkers linked to clinical behavior are required. Much is now known about the basic biology of myeloma including the key genetic abnormalities, the central signaling pathways supporting myeloma cell growth and survival, and the important role of the bone marrow microenvironment in supporting tumor cell growth. This increased knowledge has led to the potential for predicting patient outcome and giving individualized treatment based on a patients' disease biology.
Expert Rev Hematol. 2012;5(6):603-617. © 2012 Expert Reviews Ltd.