Le traitement du myélome multiple ne se résume plus aux chimiothérapies conventionnelles. Sans permettre la guérison, la chimiothérapie intensive et l'autogreffe permettent chez les sujets jeunes une prolongation notable de la survie sans rechute. Encore en cours d'évaluation, le thalidomide constitue d'ores et déjà une avancée essentielle dans les myélomes réfractaires ou en rechute. La prévention et la prise en charge des événements osseux, des infections et de l'anémie améliorent la qualité de vie. Ces innovations placent le thérapeute face à une obligation de connaissance et aux contraintes d'un choix. Ensemble, elles concourent à l'allongement global de la durée de survie dont la médiane s'élève dans la plupart des publications modernes à environ 5 ans.

Conventional chemotherapies are no longer the only treatment in multiple myelomatosis. High-dose chemotherapy and autologous transplantation are not curative but do increase relapse-free survival time in young patients. Thalidomide is efficacious in refractory and relapsing myeloma and its evaluation is going on. Curative and preventive treatments of skeletal events, infections and anemia improve quality of life. All together, these strategies imply therapeutic knowledge and choices but allow an about 5-year long median survival time in modern studies. Treatment options for myeloma now include, not only conventional chemotherapy regimens, but also novel symptomatic drugs and strategies, that increase survival and/or quality of life, although they fail to provide a cure. In parallel with this expansion of the treatment armamentarium, physicians must acquire the knowledge needed to select the best treatment for the individual patient. After reviewing the rationale, effectiveness, and safety of each of these treatments, we will discuss the indications that we believe are legitimate.