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The outlook for patients with myeloma has improved dramatically over the past few years largely because of improvements in supportive care, the use of high-dose therapy, and the introduction of the novel agents thalidomide, bortezomib, and lenalidomide. These new treatment options have changed the natural history for patients with myeloma, but clinicians must consider treatment-related toxicities. Some of the most common short- and long-term toxicities include the development of peripheral neuropathy, hematologic complications, thrombosis, and bone-related complications, such as fracture and osteonecrosis of the jaw. Careful consideration of patient-reported symptoms and appropriate dose modification or prophylaxis to prevent the development of toxicity are critical, and will result in improved quality of life and better tolerance of delivered therapy.

Treatment options for patients with newly diagnosed myeloma have evolved significantly over the past 10 years. Although response rates after induction for older or younger patients were limited, with few patients achieving complete remission, more recent combinations have cleared the way for major response and even complete remissions after induction therapy. As a consequence of these changes, patients are now achieving more durable and longer remissions, which have ultimately improved overall survival for patients with myeloma. The age-appropriate use of induction therapy, autologous transplant, and maintenance therapy, all keeping in mind the specific genetic risk group of a given patient, requires a long-term treatment plan for each patient defined early in the treatment course.