[Multiple myeloma: pathophysiology and progress in management].

There have been dramatic recent advances in understanding the basic pathophysiology and treatment strategies for multiple myeloma (MM). Research has shown both a high inter-patient diversity and intra-clonal heterogeneity even in a single patient in terms of cytogenetic/molecular abnormalities, and has also identified marked diversity in the immunological factors involved in tumor surveillance among MM patients. In the presence of a variety of novel agents, including molecular-targeted agents, immunomodulatory agents, and monoclonal antibodies, the optimal translation of current knowledge on both molecular and immunologic findings into clinical use is crucial for managing MM. In addition, the application of the decision-making process for the selection of treatment strategies, the classification of disease risk, the prediction of outcome, and disease status monitoring have greatly influenced the clinical course of MM. In this review, we summarize recent advances in understanding the pathophysiology of MM, including molecular/cytogenetic/epigenetic abnormalities and immunologic dysregulation of both tumor and immune cells. In addition, we also briefly discuss the changes/innovations in both diagnostic approaches and treatment concepts.