Multiple Myeloma. Advances in disease biology: therapeutic implications.

The survival and proliferation of multiple myeloma cells are largely dependent on a supportive microenvironment. Interleukin-6 (IL-6) is known for its ability to support cell growth and prevent apoptosis, and clinical trials using monoclonal antibodies to block IL-6 or its receptors are underway. Apoptosis of myeloma cells triggered by corticosteroids is mediated by related focal adhesion tyrosine kinase (RAFTK); blocking RAFTK inhibits this apoptosis-inducing effect IL-6 activates SHP2, which inhibits RAFTK activation, thereby protecting multiple myeloma cells from the apoptotic effects of corticosteroids. Therefore, SHP2 and RAFTK might be appropriate targets for therapeutic interventions in multiple myeloma. Angiogenesis is also prominent in the pathogenesis of multiple myeloma. Vascular endothelial growth factor (VEGF) is one of the important endogenous factors that promote angiogenesis. An understanding of the process of angiogenesis in myeloma is necessary, because its inhibition offers promising prognostic and therapeutic implications. Thalidomide has recently been found to have both antiangiogenic and immunostimulating effects, and may be an important new antimyeloma agent. Immune-based therapies will likely play an increasing role in the treatment of multiple myeloma, and novel approaches are directed to generating immune responses to specific multiple myeloma antigens.