Abstract
The prognosis of multiple myeloma (MM) has remained unchanged for three decades. The first improvement appeared in the 1990s when the Intergroupe Francophone du Myelome (IFM) 90 randomized trial showed the superiority of high-dose therapy supported by autologous stem cell transplantation (ASCT) compared with conventional dose chemotherapy in younger patients (<65 years of age) [1]. These results were confirmed by two other randomized studies [2–3]. But in less than 10 years, treatment of MM has dramatically changed due to the introduction of three novel agents: thalidomide, its analogue lenalidomide, and bortezomib. Compared with chemotherapeutic agents, these new compounds have different modes of action. They target not only the myeloma cell but also the microenvironment which is so important for myeloma cell survival and proliferation.
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