Multiple myeloma.

The mortality associated with multiple myeloma is due to the progressive accumulation of a clonal population of plasma cells in the bone marrow. Tumor cells may also be found in the blood and other extramedullary sites, especially in the terminal stages of the disease. During disease progression, numerous effects lead to significant morbidity, including immunosuppression, increased bone turnover, anemia, and renal deterioration. For more than two decades it has been realized that chemotherapy and radiotherapy could provide effective temporary relief from the pain and suffering associated with this malignancy. Unfortunately, these benefits are usually short lived, and essentially all patients experience recurrent disease that is usually refractory to additional therapy.