Since exacerbation of renal function is closely associated with the prognosis of patients, maintenance or improvement of renal function by managing the underlying KU-60019 supplier disease is required. In recent years, stratification of myeloma as high-risk and standard-risk by Mayo group has been introduced [1]. Deletion of 17p by FISH, t (14:16), Cytogenetic hypodiploidy, and β2-microglobulin >5.5 and LDH level >upper limit of normal are high risk sign. T (4:14) and cytogenetic deletion 13 are considered as intermediate risk by the reasons of overcoming with new drugs. After that, IMWG stratification is

also published; Standard-risk were Hyperdiploidy (45 % of MM mainly IgG type and aged patients), t(11;14)(q13;q32) CCND1↑, and t(6;14) CCND3↑. Intermediate-risk

were t(4;14)(p16;q32) MMSET↑ and deletion 13 or hypodiploidy by conventional karyotyping. High-risk were 17p deletion, t(14;16)(q32;q23) C-MAF↑, and t(14;20)(q32;q11) Enzalutamide purchase MAFB↑. We classified AL amyloidosis into four groups as follows; cardiac, renal, gastrointestinal and pulmonary amyloidosis, and the others according to the main organ with AL amyloid materials deposition. In this decade, novel agents (bortezomib, thalidomide and lenalidomide) have become available to treat multiple myeloma in Japan. In this article, we review the recent trend for the diagnosis and treatment strategies of multiple myeloma and AL amyloidosis by focusing on how to improve renal lesion. Diagnosis and treatment of multiple myeloma Historical perspective In 1962, Bergsagel et al. [2] reported that l-phenylalanine mustard

(melphalan) could induce remissions in approximately one third of patients with MM. In 1967, Salmon et al. [3] reported that high doses of glucocorticoids could induce remissions in patients with refractory or relapsing MM. Combination therapy with melphalan and prednisolone in 1969 by Alexanian et al. [4] showed a better result than melphalan alone. However, the response rate with alkylators and corticosteroids was only approximately 50 %, and CR was rare. Cure was never a goal of therapy as it was assumed unattainable. Instead, the goal was to control the disease as much as possible, Proteasome inhibitor providing the best quality of life to patients for the longest duration by judicious, intermittent use of the 2 available classes of active chemotherapeutic agents. Also in 1986, clinical studies evaluating HDT with single ASCT (McElwain) and double ASCT (Barlogie) were conducted. In 1996, the first randomized study showed benefits with HDT with ASCT versus standard chemotherapy. Berenson et al described an efficacy of bisphosphonate pamidronate in reducing skeletal events in patients with advanced MM.