Tracing Multiple Myeloma Across History: From Ancient Medicine to Modern Hematology and Medical Ethics

Multiple myeloma (MM), once described as a rare “Kahler’s disease,” has become a central focus of hematology and oncology in the twenty-first century. Its history reveals how biomedical progress is inseparable from broader social, political, and economic forces. From ancient conceptualizations of cancer and the early development of hematology after the invention of the microscope, to the industrial and colonial exploitation that fueled pharmacology, MM therapy has been shaped by contexts far beyond the laboratory. Wars and geopolitical competition accelerated advances in oncology and immunology, producing both devastating tragedies, such as thalidomide, and durable breakthroughs, such as melphalan. The biotechnology revolution of the late twentieth century introduced proteasome inhibitors and monoclonal antibodies, culminating in the approval of CAR-T cell therapies, which offer survival gains once unimaginable. Yet these advances also expose profound inequities: CAR-T remains limited to a handful of countries and priced beyond the reach of most patients. The COVID-19 pandemic further highlighted both the speed of biomedical innovation and the fragility of equitable delivery, underscoring the tension between discovery and access. By tracing the trajectory of MM from antiquity to the modern era, this article demonstrates that medical innovation must be understood not only as scientific progress but also as a reflection of humanity’s struggles with power, inequality, and responsibility.