Multiple Myeloma and Related Disorders PDF

Preface

Since the publication of our original book on multiple myeloma in 1996, there has been an enormous increase in knowledge about the disease: more than 5000 articles have been published in scientific journals. The development has been impressive both in the basic knowledge about the disease and in its treatment.

New technologies have made it possible to refine studies on chromosomes and genes and to gain information about gene expression.Microarray is in its early stage, but already there have been pattern descriptions that may have prognostic implications.

We have learned not only that deletions of chromosome 13 are important but also that chromosome 14 translocations involving candidate oncogenes on other chromosomes, such as Cyclin D1 or FGFR3, may be even more important in the pathogenesis of the disease. The prognostic impact of chromosomal abnormalities is now clearer than before, and the complicated interaction between the stroma cells, the myeloma cells, and numerous cytokines and their receptors has been better explained. Most importantly, attempts have been made to utilize this new knowledge to develop targeted therapy and, although results are still modest, improvements have been obtained with thalidomide and analogs, as well as with proteasome inhibitors, such as bortezomib. Many other approaches to targeted therapy are being attempted and are reviewed.

Very important progress has been made in stem-cell transplantation and it is now confirmed in more than one prospective study that high-dose therapy with autologous transplantation is superior to conventional chemotherapy for patients under 65 years of age. It also seems that tandem transplantation may be superior to single autologous transplantation, at least for subgroups of patients. Interesting attempts are being made to decrease the intensity of the conditioning regimen for allogeneic transplantation, and to utilize the immune effect of the donor marrow and donor lymphocytes.

These and other new developments, not only in multiple myeloma, but also in related disorders, such as amyloid light-chain amyloidosis, heavy-chain disease, and Waldenström's macroglobulinemia, are described in this new, expanded book. Each chapter area is able to stand alone; thus, there is some deliberate overlap between chapters.

With this approach, our hope is that the book will be of interest not only for scientists and specialists in the field, but also for practitioners and non-specialists with an interest in basic aspects of treatment of patients with multiple myeloma.