In the last decades, advances in the therapeutic management of multiple myeloma (MM) with new drug armamentarium and strategies have significantly improved the outcome and survival of newly diagnosed and relapsed patients. However, the continuing challenges physicians are facing within specific clinical settings and patient subpopulations, whose prognosis with current strategies is extremely poor, call for a paradigm change. New immunomodulators, proteasome inhibitors, histone deacetylase inhibitors, and monoclonal antibodies are being explored to improve first-line outcomes so that a smaller proportion of patients relapse early or fail to respond to induction treatment. Moreover, recent advances and clinical evidence with novel therapies seem to provide patients with relapsed or refractory MM additional survival benefits. Improving clinical outcomes and refining standard of care should help clinicians reduce the burden of multiple and toxic therapy; quality of life (QoL) should be at the core of MM management. Patient selection and stratification needs to be reinforced with the help of comprehensive knowledge on conventional risk factors, and supplemented by molecular pathways in the near future in order to provide tailored options and strategies to patients, including the use of monoclonal antibodies. Numerous drugs are on the horizon and the next few years should witness marked improvements in survival, QoL, and safety of MM management.
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