Recent progress in the biology of multiple myeloma and future directions in the treatment

J. L. Pico, L. Castagna, J. H. Bourhis

Research output: Contribution to journalArticlepeer-review

Abstract

A great amount of scientific information, accumulated over recent years on the biology of Multiple Myeloma (MM), has fuelled speculation about the origin of malignant plasma cells, about a purported critical role played by the bone marrow stroma, and further still, on cytokine interactions and in particular that of IL-6 and its relationship with the immune system. Among the growth factors secreted by stroma cells, IL-6 is a potent stimulator of myeloma cells in vitro but does not induce a malignant phenotype in normal plasma cells. Many efforts have been produced to identify the stem cell in MM and probably memory B lymphocytes are the best candidates. The demonstration of a Graff vs Myeloma effect in the allogeneic setting strongly supports the immunotherapy in MM. Recent data also suggest that a virus (Kaposiassociated herpes virus, HHV-8) may be significantly associated with the development of MM. In parallel, progress has been achieved in the treatment of this incurable disease with well defined prognostic factors, more efficient supportive care and its corollary, improved quality of life and dose- intensified chemo-radiotherapy followed by autologous hematopoietic stem cell support. Improving the quality of grafts with the selection of CD34 positive cells is another approach aimed at reducing plasma cell contamination without impairing haematological recovery. An EBMT randomised study assessing the role of CD34 selection has been initiated by our group. Increasingly efficient first-line therapy, better quality autografts and improved post- remission treatment with, for exemple, anti-idiopatic vaccination are the most promising future directions.

Original languageEnglish
Pages (from-to)45-61
Number of pages17
JournalHematology and Cell Therapy
Volume40
Issue number2
Publication statusPublished - Apr 1998

Keywords

  • Biology
  • Multiple myeloma
  • Pathogeny
  • Prognostic factors
  • Treatment

ASJC Scopus subject areas

  • Hematology

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