Summary. The role of serum macrophage inflammatory protein-1 alpha (MIP-1α) in bone disease and survival was evaluated in 85 newly diagnosed multiple myeloma (MM) patients. MIP-1α was elevated in MM patients and correlated with the extent of bone disease, bone resorption markers and levels of soluble receptor activator of nuclear factor-κB (RANK) ligand. MIP-1α was also associated with survival; the 3-year probability of survival was 85% and 44% for MIP-1α levels below and above 48 pg/ml respectively (P = 0·021). This suggests that MIP-1α contributes to the pathogenesis of bone disease in MM and possibly in tumour growth, as reflected by its impact on survival.