**Author details**

responses and become long-term survivors, being some of them cured, the goal of curing MM in a significant proportion of patients is still far away. In the current scenario, getting and maintaining a minimal residual disease has become the primary objective of therapy before cure [29]. In the meantime, the importance of improving quality of life should be pointed out [138].

Based on data from the SEER Program [42], MM is the fourteenth leading cause of cancer death in the United States. The number of deaths was 3.3 per 100,000 men and women per year

Comorbidity has also an impact on mortality, in particular, early mortality [57]. Infection remains as the first cause of death in most studies, frequently associated with aging, renal failure, and relapse. Therefore, every effort to avoid serious infection should be taken into

Little is known about effective measures to avoid the development of MM. Early treatment of asymptomatic patients with high-risk SMM or even high-risk MGUS, now only in the context of clinical trials, may prevent the appearance of MM, increasing the probability of cure [140]. Currently, the potentially preventable risk factors for MM are obesity and the exposure to MM-related carcinogens, particularly in the context of farming. Efforts should be made to

On the other hand, the prevention of treatment-related adverse events is a matter of concern

• MM is a very complex and heterogeneous disease. Heterogeneity is largely responsible for the great variability in the outcome of patients and can be stratified in several levels. Epidemiology should be considered the first level of heterogeneity. Therefore, the knowledge of the epidemiological background should be taken into account in both real-life and clinical trials settings to accurately assess the outcome, allowing a precise comparison between studies. • MM epidemiology is an exciting research topic. In the era of precision and personalized medicine, both clinical and molecular epidemiology should be integrated as a mandatory

• MM is a multistep malignancy. Virtually all patients with NDMM had a previous precursor disease. However, the proportion of NDMM patients with a previously known precursor disease is remarkably small. Both MGUS and SMM have also a heterogeneous pattern of risk progression. Early treatment in high-risk SMM is expected to increase the

account. In this regard, prophylactic antibiotics [139] and vaccines are key measures.

**2.4. Mortality**

20 Update on Multiple Myeloma

**2.5. Prevention**

[141].

**3. Conclusions**

rate of cure.

(age-adjusted rates), based on 2010–2014 deaths.

fight globally and effectively against these risk factors.

step in the optimized workup of every patient.

Rafael Ríos-Tamayo1,2,3,4,5\*, Dolores Sánchez Rodríguez1,7, Yoe-Ling Chang-Chan4,6 and María-José Sánchez Pérez4,5,6

\*Address all correspondence to: rriost33@gmail.com

1 Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain

2 Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain

3 Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research, Pfizer/ University of Granada/Andalusian Regional Government, PTS, Granada, Spain

4 Biosanitary Research Institute of Granada (Ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain

5 CIBER of Epidemiology of Public Health (CIBERESP), Madrid, Spain

6 Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain

7 FIBAO, Granada, Spain
