The treatment of multiple myeloma has undergone significant changes and has resulted in the achievement of molecular remissions, the prolongation of remission duration, and extended survival becoming realistic goals, with a cure being possible in a small but growing number of patients. In addition, nowadays it is possible to categorize patients more precisely into different risk groups, thus allowing the evaluation of therapies in different settings and enabling a better comparison of results across trials. Here, we review the evidence from clinical studies, which forms the basis for our recommendations for the management of patients with myeloma. Treatment approaches depend on "fitness," with chronological age still being an important discriminator for selecting therapy. In younger, fit patients, a short three drug-based induction treatment followed by autologous stem cell transplantation (ASCT) remains the preferred option. Consolidation and maintenance therapy are attractive strategies not yet approved by the European Medicines Agency, and a decision regarding post-ASCT therapy should only be made after detailed discussion of the pros and cons with the individual patient. Two- and three-drug combinations are recommended for patients not eligible for transplantation. Treatment should be administered for at least nine cycles, although different durations of initial therapy have only rarely been compared so far. Comorbidity and frailty should be thoroughly assessed in elderly patients, and treatment must be adapted to individual needs, carefully selecting appropriate drugs and doses. A substantial number of new drugs and novel drug classes in early clinical development have shown promising activity. Their introduction into clinical practice will most likely further improve treatment results.

Department of Oncology Hematology and Palliative Care Wilhelminenspital Vienna Austria; Department of Hematology Erasmus Medical Center Rotterdam The Netherlands; Institute of Cancer Research Royal Marsden Hospital London United Kingdom; Department of Hematology Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clinic Barcelona Spain; Divisione di Ematologia dell'Università di Torino Azienda Ospedaliera S Giovanni Battista Ospedale Molinette Turin Italy; Institute of Hematology and Medical Oncology Seragnoli Bologna Italy; Haemato Oncology Unit Royal Marsden Hospital Surrey United Kingdom; Hematology Service University Hospital La Fe Valencia Spain; Department of Hematology University Hospital Leuven Belgium; Department of Clinical Therapeutics University of Athens School of Medicine Athens Greece; Universitätsklinik Würzburg Medizinische Klinik und Poliklinik 2 Würzburg Germany; Service d'Hématologie Centre Hospitalier Universitaire Lille France; Department of Internal Medicine 5 University of Heidelberg Heidelberg Germany; University Hospital Nantes France; Karolinska Institute Stockholm Sweden; Department of Hematology Center Lillebaelt University of Southern Denmark Odense Denmark; Clinica Universidad de Navarra Centro Investigaciones Medicas Aplicada Pamplona Spain; Department of Hemato oncology University of Ostrava Ostrava Czech Republic; University of Giessen Giessen Germany

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