Major improvement milestones in the treatment of patients with
multiple myeloma (MM) include the introduction of the
melphalan/
prednisone combination in the 1960s, high-dose
chemotherapy supported by autologous stem cell transplant in the 1980s, and the more recent introduction of the novel agents
thalidomide,
lenalidomide, and
bortezomib. Historically, age and eligibility for autologous
stem cell transplantation were the primary basis for treatment selection, but, from a biologic standpoint, MM
therapy was "one size fits all," in that
therapy was not tailored based on molecular or other features that define subtypes of MM. Recently, novel
therapies have extended overall survival for the broad spectrum of patients with myeloma. Moreover, newer data demonstrate that novel
therapies may ameliorate the prognostic impact of predictors of high risk and poor outcome in MM, which suggests that patients with MM and with high-risk disease should receive novel agents. Such approaches may constitute nascent steps toward individualized
therapy, ie, the selection of highly effective
therapies based on specific features exhibited by an individual patient's MM. However, prospective data that demonstrate the validity of these approaches are lacking. Definitive, multi-institutional clinical trials are required before redefining standards of myeloma care based on this approach.