ABSTRACT
Multiple myeloma (MM) continues to present a therapeutic challenge. In spite of new approaches to treatment, MM at present remains incurable, with a median survival of between 3 and 4 years. Treatment produces a response in approximately two-thirds of patients, with a fall in paraprotein and improvement or resolution of clinical symptoms. However, complete remission (CR) is very rare, except after high-dose therapy, and in most patients the paraprotein falls but reaches a plateau after a few months of treatment. At this stage, the patient is said to be in ‘plateau phase’. Sooner or later the paraprotein starts to rise again, indicating relapse, or there may be a recurrence of symptoms. Further treatment at this stage, perhaps with a different drug or drug combination, may again produce a response, but the duration of response is usually shorter than that of the initial remission. Eventually, the disease becomes refractory to treatment and the patient succumbs to infection, renal failure, or other disease complication.
