Multiple Myeloma

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Abstract
Before proceeding to treatment selection for multiple myeloma, it is important to exclude monoclonal gammopathy of unknown significance or any similar smouldering or indolent type of myeloma not requiring immediate chemotherapy. In patients with active myeloma, pretreat- ment prognostic classification is important for appropriate balancing of the risks and benefits of particular treatment options. For example, conventional chemotherapy such as melphalan/prednisone may be appropriate for an elderly patient with active stage III myeloma, whereas high dose chemotherapy with or without bone marrow transplantation or cytokine support may be considered for the patient under age 45 with even eariier stage disease. A variety of options are now available for patients iwith relapsing or resistant disease, particularly using agents with potential for reversal of multi-drug resistance. The use of interferon-α as maintenance following initial response to chemotherapy is important for prolongation of remission, duration and potentially survival. A variety) of supportive measures are also helpful including the use of epoetin (erythropoeitin) to improve refractory anaemia and bisphosphonates for the inhibition of ongoing bone resorption. With the availability of various treatment options, it has become important for patients to be evaluated by a specialist in the field.