The last decade has seen rapid evolution in the management of multiple myetoma. Cytogenetic, molecular, and proteomic techniques have led to a better understanding of the pathophysiology and prognostic markers of this heterogeneous malignancy. New immunomodulatory drugs, such as lenalidomide, which interrupt myetoma growth and survival. pathways have entered into clinical usage. Combined with dexamethasone, oral lenalidomide has proved to be highly effective in patients whose disease has become resistant to conventional therapy. Currently, several. clinical trials are ongoing in order to define the optimal. use of this new agent and its combinations across the spectrum of patients with myetoma. Whether the ultimate outcome of future research wilt be a single-treatment solution for all patients, or whether treatments will become better-tailored to the individual (based on prognostic markers and preexisting co-morbidities) has yet to be determined. (c) 2007 Elsevier Ltd. All rights reserved.