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Exosomes are small vesicles ranging in size between 30 and 150 nm, derived from the luminal membranes of the endosome and are constitutively released by fusion with the cell membrane. Several studies have revealed that exosomes play crucial roles in mediating local and systemic cell communication through the horizontal transfer of information in the form of nucleic material and proteins. This is particularly relevant in the context of the tumor-microenvironment cross talk. Here we describe the method of isolating exosomes and their role in modifying the tumor environment and more specifically in enabling metastasis and promoting angiogenesis.

Multiple myeloma (MM) is an incurable disease that progresses from a premalignant stage termed monoclonal gammopathy of undetermined significance (MGUS) and an intermediate stage of smoldering multiple myeloma (SMM). Recent major advances in therapy with more effective and less toxic treatments have brought reconsideration of early therapeutic intervention in management of SMM, with the goal of reducing progression of the disease before the occurrence of end-organ damage to MM and improving survival. Key to this effort is accurate identification of patients at high risk of progression who would truly benefit from early intervention. In this review, we discuss the current definitions, risk factors, risk stratification, prognosis, and management of MGUS and SMM, as well as new emerging therapeutic options under active investigation.