Preface

Chapter 7 **The Role of Radiology and Radiotherapy for**

Milda Rudzianskiene, Viktoras Rudzianskas, Ruta Dambrauskiene

Chapter 8 **Infections in Patients with Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies 181** Asma M. Al-Jasser and Khalid Ahmed Al-Anazi

Chapter 9 **Management of Multiple Myeloma in Developing**

**Multiple Myeloma 159**

**VI** Contents

**Countries 207**

and Rolandas Gerbutavicius

Ogbonna Collins Nwabuko

Over the past two decades, the outcome of patients with multiple myeloma has improved substantially due to the increased understanding of disease biology, introduction of ad‐ vanced diagnostics and several novel therapies, evolution of new therapeutic strategies, and recent improvement in supportive care.

This book represents an update on multiple myeloma. It is divided into three sections that cover a wide range of topics, which include: epidemiology and pathogenesis of the disease, genetic targets and pathways, resistance to novel therapies, angiogenesis and anti-angiogen‐ esis, hematopoietic stem cell transplantation, role of radiology and radiotherapy in myelo‐ ma, infectious complications, and management of myeloma in resource-poor countries. Each chapter is written by scientists and clinicians with expertise in the field.

I would like to thank the authors for their valuable contributions, as well as the publishing manager Lada Bozic and IntechOpen staff for their remarkable efforts that ultimately made this book project a reality.

> **Khalid Ahmed Al-Anazi** Oncology Center King Fahad Specialist Hospital Dammam, Saudi Arabia

**Section 1**

**Introduction and Epidemiology of Multiple**

**Myeloma**

**Introduction and Epidemiology of Multiple Myeloma**

**Chapter 1**

**Provisional chapter**

**Introductory Chapter: Multiple Myeloma in the Era of**

**Introductory Chapter: Multiple Myeloma in the Era of** 

Multiple myeloma (MM), the second most common hematologic malignancy (HM), is a malignant B-cell neoplasm that is characterized by clonal expansion of plasma cells in the bone marrow (BM) with subsequent production of monoclonal immunoglobulins [1–8]. The disease has several complications including anemia; renal dysfunction or failure; bone involvement including osteopenia, lytic lesions, and pathological fractures; hypercalcemia; immunodeficiency; and various infectious complications [1, 4, 5, 7–12]. The incidence of MM has increased since the year 1990 with the largest increase in resource-poor countries [13]. MM is a heterogeneous disease even in its etiology, and there are several risk factors for the disease that include old age; obesity; ionizing radiation; exposure to solvents and pesticides; agricultural occupations; autoimmune disorders such as pernicious anemia and ankylosing spondylitis; monoclonal gammopathy of undetermined significance; and familial predisposition [14–18]. One hallmark of MM is the presence of heterogeneous chromosomal aberrations and numerous genetic mutations that not only can help in risk stratifying the disease but also can affect management and prognosis to a large extent [7, 8, 19]. Recently, MM is stratified according to stage of the

disease, plasma cell labeling index, cytogenetics, and gene expression profiling [20–22].

Over the past two decades, the outcomes of patients with MM have improved substantially even in patients with relapsed or refractory (RR) disease [1–4, 23–28]. The remarkable improvement in the outcome of MM is due to the following reasons: (1) the evolution of advanced technology that facilitated understanding biology of the disease and helped in the diagnosis, risk stratification, and follow-up of patients; (2) the introduction of several novel therapies, monoclonal antibodies, and immunotherapies; (3) the widespread utilization of high-dose (HD) chemotherapy followed by autologous stem cell transplantation (HSCT); (4) the recent improvements in supportive care and antimicrobial therapies; and (5) the evolution of new

> © 2016 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.

© 2018 The Author(s). Licensee IntechOpen. 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.

DOI: 10.5772/intechopen.82174

**Novel Therapeutics**

**Novel Therapeutics**

Khalid Ahmed Al-Anazi

**1. Introduction**

Additional information is available at the end of the chapter

Khalid Ahmed Al-AnaziAdditional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.82174

#### **Introductory Chapter: Multiple Myeloma in the Era of Novel Therapeutics Introductory Chapter: Multiple Myeloma in the Era of Novel Therapeutics**

DOI: 10.5772/intechopen.82174

Khalid Ahmed Al-Anazi

Additional information is available at the end of the chapter Khalid Ahmed Al-AnaziAdditional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.82174
