Multiple Myeloma is a hematologic malignancy characterized by the abnormal proliferation of plasma cells. Therapy for this disease has largely been palliative, and chances for long term survival after initiation of treatment have been quite limited. In the era of molecular therapies, a better understanding of the molecular biology resulting in the development of myeloma have shed light on a number of novel and potentially exciting therapeutic options for this disease which previously had limited options. This review will discuss some of the basic mechanisms of current therapy such as corticosteroids and alkylating agents, as well as developing such as the proteasome inhibitors, thalidomide and its analogs, arsenic trioxide, anti-sense technology, and others. The final section will assess the potential for new targeted approaches to treatment for mechanisms which have yet to be fully explored, and for agents which are in early phase I development