**3. Treatment strategy and treatment line**

variety of new drugs are being tested in clinical studies at phases I/II. In MM treatment, modern target therapies are being tested, such as monoclonal antibodies, kinase inhibitors or inhibitors of other target molecules connected to one of the signaling pathways important for malignant cells. Although treatment results of this group of drugs failed to reach expectations, we feel that they will produce very promising results in the future. Current treatment strategies will lead to a cure – a topic which is being discussed very seriously. In this chapter, the current

Our current treatment strategies originate from a variety of research data that may be shortly

**a.** Every MM is preceded by a precancerosis called monoclonal gammopathy of undeter‐ mined significance (MGUS) in [8]. Individual stages starting from the occurrence of first clonal plasmocyte to MGUS, MM, refractory MM up to plasmocellular leukemia are concurrent; in one individual, they may be described as disease progression changing in time. Many internal and external factors influence the phase when the initial plasmocyte

> Early myeloma

> > **1. RELAPSE**

**Plateau remission**

**2. RELAPSE**

myeloma

**Second-line Third-line** 

**REFRACTORY RELAPSE**

Plasma cell leukemia

state of affairs as well as the potentials of pharmacotherapy in MM will be discussed.

**2. Basic scientific data influencing current treatment strategies**

will develop into hematological malignancy requiring therapy (Fig.1).

**Asymptomatic Symptomatic**

expansion MGUS Late

**First-line therapy** 

**ACTIVE MYELOMA**

**MGUS or smoldering myeloma**

MGUS, monoclonal gammopathy of undetermined significance

**M-protein (g/L)**

**20**

**Figure 1.** Natural history of multiple myeloma

**50**

**100**

Clonal

2 Multiple Myeloma - A Quick Reflection on the Fast Progress

described as follows:

When deciding on a treatment, it is necessary to plan a complex treatment – not only anticancer treatment but also supportive treatment; it is important to think about relapse at the time of initial treatment, which drugs to use so that initial treatment does not block further steps in the future. Autologous transplantation is a basic part of treatment wherever possible. Today, treatment strategies use optimal choices of treatment lines, in an individual that should cover 5-7 disease activities within 10 years of treatment if necessary.
