Despite several recent therapeutic advances, multiple myeloma (MM) remains incurable, and unfortunately most patients experience relapse after responding to initial therapies, including high-dose chemotherapy and stem cell transplantation (SCT). Long-term remissions are rare. With conventional chemotherapy, the 5-year median survival rate is approximately 25%, and approximately 10% of patients live longer than 10 years.1 Multiple regulatory pathways involving cytokines, adhesion molecules, angiogenesis, and resistance mechanisms contribute to the development and progression of the disease. The complex pathophysiology of MM makes it difficult to manage the disease successfully. Over the past 5 years, remarkable improvement in the understanding of the disease biology has resulted in the development of targeted therapy interrupting single or multiple survival pathways for the disease. Newer agents have been developed that have provided hope for better management of relapsed and refractory MM. Further research is ongoing to target multiple pathways of the disease simultaneously for more efficient and durable treatment of the disease.

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