**1. Introduction**

Multiple Myeloma (MM) is the most common type of plasma cells cancer that mount up from bone marrows, and leads to osteodysfunction and marrow failure [1, 2]. It is second to non-Hodgkin lymphoma as the most common hematologic malignancy [3]. Majority of the MM patients who develop Monoclonal Gammopathy of Undetermined Significance (MGUS) are initially pass through the stage of asymptomatic pre-malignancy [4, 5]. The conversion of MGUS to MM is around 1% per annum, and the more advanced form of pre-malignant stage termed as Smoldering (or indolent) MM (SMM) can also be seen in some patients, that has a progression rate of 10% per annum over the first 5 years of diagnosis, 3% per year over the following 5 years, and 1.5% per year thereafter [4–6].

The European Myeloma Network (EMN) provides recommendations for the management of the most common complications of MM. The whole body low-dose computed tomography (LDCT) is now considered as novel in detecting lytic lesions, and more sensitive than conventional radiography in depicting osteolytic disease as per the recommendations of the EMN [7, 8].

The treatment landscape and clinical outcome of MM have changed in the last two decades, with an improved median survival of 8–10 years [9]. The initial impact seen with the introduction of three drugs, thalidomide, bortezomib, and lenalidomide [10]. Multiple combinations of proteasome inhibitors (PIs) like bortezomib, carfilzomib, and ixazomib; immunomodulatory drugs (IMIDs) such as Thalidomide, lenalidomide, and pomalidomide; corticosteroids (Cs) such as dexamethasone, prednisone; monoclonal antibodies (MAs) like Daratumumab and isatuximab; and alkylating agents such as melphalan, cyclophosphamide have been tried and evaluated in the transplant and non-transplant settings, and studies are still ongoing [9]. The approval of carfilzomib, pomalidomide, panobinostat, ixazomib, elotuzumab, and daratumumab by the Food and Drug Administration (FDA) for the treatment of relapsed multiple myeloma, in the last five years is an step closer to radical cure [10].
