Although multiple myeloma (MM) remains an incurable disease, the advent of novel treatment paradigms has improved survival outcomes in the past two decades. This includes widespread use of high-dose chemotherapy with autologous stem cell transplantation (HDT–ASCT) and the development of the novel agents thalidomide, lenalidomide and bortezomib. The efficacy and tolerability of these novel agents have allowed for the exploration of continuous therapy approaches. Maintenance therapy after HDT–ASCT, for example, may help prolong progression-free survival by providing sustained control of residual disease. Trials are also under way to evaluate lenalidomide in patients with high-risk smoldering MM, with the aim of delaying progression to symptomatic MM. Other research is focusing on improving HDT–ASCT protocols and integrating novel agents, such as bortezomib, as an induction or consolidation therapy. Despite these advances, more effective strategies are needed, particularly for the management of older, less fit patients who are ineligible for HDT–ASCT. Preliminary results on the use of lenalidomide maintenance therapy in elderly patients are encouraging. Taken together, these observations indicate that in this era of novel agents, optimal treatment of MM requires a long-term perspective that focuses on providing sustained disease control while maintaining quality of life.

尽管多发性骨髓瘤 (MM) 仍然是一种无法治愈的疾病，但在过去的二十年中，新型治疗模式的出现改善了生存结果。这包括广泛使用自体干细胞移植 (HDT-ASCT) 的大剂量化疗，以及开发新型药物沙利度胺、来那度胺和硼替佐米。这些新型药物的功效和耐受性允许探索连续治疗方法。例如，HDT-ASCT 后的维持治疗可能通过提供对残留疾病的持续控制来帮助延长无进展生存期。评估来那度胺在高危冒烟型 MM 患者中的试验也在进行中，目的是延缓进展为有症状的 MM。其他研究的重点是改进 HDT-ASCT 协议和整合新的代理，如硼替佐米，作为诱导或巩固治疗。尽管取得了这些进展，但仍需要更有效的策略，特别是对于不适合 HDT-ASCT 的年龄较大、体质较差的患者的管理。在老年患者中使用来那度胺维持治疗的初步结果令人鼓舞。综上所述，这些观察结果表明，在这个新药时代，MM 的最佳治疗需要有长远的眼光，专注于在保持生活质量的同时提供持续的疾病控制。