Targeted therapy of multiple myeloma.

The diagnosis of multiple myeloma requires the presence of monoclonal bone marrow plasma cells, a monoclonal (M) protein in serum and/or urine and evidence of end-organ damage from the plasma cell proliferative disorder. Initial therapy for transplant-eligible patients includes thalidomide, bortezomib or lenalidomide, all with dexamethasone. Stem cells for a possible autologous stem cell transplant (ASCT) should be collected if the patient is considered eligible for an ASCT. Initial therapy for patients ineligible for an autologous stem cell transplant includes melphalan and prednisone as well as thalidomide, bortezomib or lenalidomide. More than 100 agents are in phase I, II or III clinical trials. The most promising are carfilzomib and pomalidomide.