**Author details**

Magdalena Patricia Cortés1 , Rocío Alvarez2 , Jessica Maldonado4 , Raúl Vinet3 and Katherine Barría4

1 Department of Biochemistry, Faculty of Pharmacy, Universidad de Valparaíso, Valparaíso, Chile

2 Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidad de Valparaíso, Valparaíso, Chile

3 Laboratory of Pharmacology and Biochemistry, Faculty of Pharmacy, Universidad de Val‐ paraíso, Valparaíso, Chile

4 Hospital Almirante Nef, Viña del Mar, Chile

#### **References**

disease progression [65]. Dynamic changes in tumor and microenvironment, cell immunophe‐ notype, mRNA and protein expression, should offer insight into disease progression [57, 78].

In conclusion, it is crucial to follow up cases of MGUS carefully, including their systematic recording as a fundamental contribution to understand the evolution of this pathology and its malignant transformation process. This will be critical to develop better biomarkers that contribute to understand the evolution and malignant transformation of MGUS. These efforts should lead to the development of new, more effective management and treatment strategies.

CRAB Hypercalcemia, renal insufficiency, anemia and bone lesions

MGUS Monoclonal gammopathy of undetermined significance

, Rocío Alvarez2

, Jessica Maldonado4

1 Department of Biochemistry, Faculty of Pharmacy, Universidad de Valparaíso, Valparaíso,

2 Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidad de Valparaíso,

3 Laboratory of Pharmacology and Biochemistry, Faculty of Pharmacy, Universidad de Val‐

, Raúl Vinet3

and

FISH Fluorescence *in situ* hybridization

124 Multiple Myeloma - A Quick Reflection on the Fast Progress

SMM Smoldering multiple myeloma

**8. Conclusion**

**Abbreviations**

**Author details**

Katherine Barría4

Valparaíso, Chile

paraíso, Valparaíso, Chile

4 Hospital Almirante Nef, Viña del Mar, Chile

Chile

Magdalena Patricia Cortés1

IL interleukin κ Kappa λ Lambda

MM Multiple myeloma M-protein Monoclonal protein NF-κB Nuclear factor-κB


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**Chapter 7**

**Induction Therapy in Multiple Myeloma**

Today, multiple myeloma (MM) can be defined as a heterogenous disease composed of different clinical conditions. The differences are a result of patient related factors (age, sex, comorbidity), disease related complications (renal failure, bone disease, neuropathy, throm‐ bosis) and biological characteristics (cytogenetics, lactate dehydrogenase level, plasma cell labelling index, beta2-microglobulin, gene expression profiles). The widely used international scoring system is a powerful tool for determining survival. However, it cannot be used for treatment planning. The biological determinants of disease determined by flourescein in situ hybridization (FISH) and/or conventional cytogenetics are better tools to stratify myeloma subgroups with different survival profiles. Thus these are better tools for designing therapeutic approaches. A risk stratification of newly diagnosed MM according to FISH/Karyotyping has

High dose melphalan supported by autologous stem cell transplantation (ASCT) can increase response rates and prolong progression free and overal survival compared to conventional chemotherapies (Attal et al., 1996; Child et al., 2003; Fermand et al., 2005; Koreth et al., 2007). The initial induction regimen is chosen according to whether the patient is eligible or ineligible for a subsequent HDT-ASCT as well as the risk stratification of the patient. Advanced age or significant comorbidity are important limitations for ASCT. High dose therapy has been generally considered for patients ≤ 65 years. However, in medically fit patients, this can be extended up to age 70-75 years. Achievement of high quality responses (VGPR, CR/nCR) at the time of transplantation has been demostrated to be an early predictor of improved outcomes after ASCT (Harousseau et al., 2009; Chanan-Khan&Giralt, 2010). Elderly patients or patients ineligible for transplantation may also benefit from chemotherapy by achieving high quality responses preferably CR in terms of progression free survival (PFS) and overall survival (OS). As such, the choice of induction therapy is crucial for survival for most patients with MM. The emergence of novel agents (thalidomide, lenalidomide and bortezomib) and

> © 2013 Bakanay and Beksac; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

> © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

and reproduction in any medium, provided the original work is properly cited.

Sule Mine Bakanay and Meral Beksac

http://dx.doi.org/10.5772/55151

**1. Introduction**

Additional information is available at the end of the chapter

been recently reviewed by Rajkumar (Rajkumar, 2012).

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