Myeloma therapy-a new paradigm

New drugs with novel mechanisms of action are being developed; these are not curative, but there is already evidence of high response rates; improved survival; and, for some patients, alteration of the nature of this disease into an episodic illness requiring intermittent treatment. Thalidomide and its analogs (lenalidomide and thalidomide have both been approved for the treatment of myeloma) also induce other inflammatory cytokines, expand natural killer cells, modulate cell adhesion molecules, and induce apotosis of myeloma cells. The therapeutic benefits of these drugs are largely mediated by their effects on the bone marrow microenvironment as opposed to direct effects on myeloma cells.