The increased incidence of MM in the last 50 years is indicative of improved diagnosis of the disease and the vigorous evaluation of the increasingly aging population rather than an actual increase in incidence. MM clinical presentations range from a benign disease requiring no therapy to an aggressive malignancy reflecting the complex processes involved in initiation and propagation of the malignant clone. Genetic abnormalities possibly represent initial events that are acquired or inherited and remain dormant until environmental factors promote the proliferation of the malignant clone. Then the clone is sustained through a network of cytokines and cellular elements in the bone marrow microenvironment. The contributions of race, sex, infection, various chemicals, and hereditary factors to this process remain under investigation. Despite extensive studies, the etiology of the disease remains elusive. The studies of the genetic background, using gene array and related technologies, have provided a new opportunity to correlate specific genes with the progress of the disease.

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