Background: Multiple myeloma is a malignancy of plasma cells originating from the bone marrow; it is a clonal plasma cell disorder that produces excess monoclonal immunoglobulin. The disease most commonly presents with hypercalcemia, renal failure, anemia and bone lesions (CRAB features). Myeloma accounts for about 10% of all hematological malignancies. The annual incidence of myeloma in Australia is about five cases per 100 000 population, and there are about 1200 new patients diagnosed each year; the median age of diagnosis is the mid-60s. There is variation in incidence among the different ethnic groups, with myeloma being twice as common in African Americans than in white people and less common in Asians. From the early 1960s until the early 2000s, melphalan chemotherapy with addition of steroids (prednisone or dexamethasone) formed the basis for treating multiple myeloma. Melphalan was also used both in conditioning chemotherapy, which ablates the bone marrow before autologous stem cell transplantation, and for the treatment of patients deemed unsuitable for transplantation. There has recently been progress in the treatment of myeloma with the development of new targeted therapies, which include thalidomide, lenalidomide and bortezomib. These newer agents have significantly changed the treatment strategies Patients with a clonal plasma cell disease and signs of manifest or threatened organ damage must receive adequate systemic therapy. Although this does not generally lead to cure, modern treatment plans have now increased the 5-year survival rate for myeloma patients up to 75 years of age to over 50%. In 3–20% of patients, complete remission can last for many years. In the absence of severe (cardiac and pulmonary) comorbidities, the standard treatment in Germany remains high-dose melphalan (200 mg/m2) followed by retrains fusion of autologous blood stem cells

Treatment, Multiple Myeloma