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Summary The purpose of the study was to ascertain whether the prognostic significance of staging in multiple myeloma (MM) is influenced by the aggressiveness of effective induction treatment and/or by continuing or discontinuing maintenance chemotherapy. Patients patients, still independent of both induction and post-induction policies. In MM, the significance of staging for survival is independent of both the aggressiveness of induction policy and of continuing or discontinuing maintenance chemotherapy after the maximal tumour reduction has been achieved. Both MPH-P and the association of PTC, VCR and P are effective in inducing first response and also second response in patients failing on the alternative regimen, but PTC-VCR-P causes more side-effects. Thus, the overwhelming majority of patients with MM can safely be given MPH-P as first therapy, and this treatment may be delayed in early disease.Attempts to improve survival of the general population of patients with multiple myeloma (MM) have been focused mainly on chemotherapies more aggressive than the standard melphalan-prednisone (MPH-P) regimen, irrespective of the extent of the disease. Little has been done to evaluate, in prospective studies, the survival value of tailoring therapy according to the stage of the disease, as is done with several other tumours in spite of there being no doubt that early Correspondence: A. Riccardi,

In 16 patients with monoclonal gammopathies of undetermined significance (MGUS) and in 49 with multiple myeloma (MM, 43 untreated and 6 relapsed) we used immunocytochemistry to determine the percentages of bone marrow plasma cells (BMPC) that incorporate bromodeoxyuridine (BUDR-labeling index, BUDR-LI) in vitro and that label with the monoclonal antibody Ki-67 (which recognizes an antigen thought to identify the growth fraction of the population, Ki-67 GF). Both mean and range values were greater for Ki-67 GF than for BUDR-LI. Most patients with high Ki-67 GF also had high BUDR-LI, although a linear correlation was not found between the two parameters. MGUS has lower values than MM, and the difference was much greater for Ki-67 GF than for BUDR-LI (p < 0.005 vs. p < 0.05). Differences in Ki-67 GF but not in BUDR-LI were found between MGUS and stage I MM (p < 0.0005) and between grouped stage I and II MM and stage III MM (p < 0.025). Both Ki-67 GF and BUDR-LI were significantly (p < 0.005) greater in relapsed than in untreated MM. Determining Ki-67 GF as a proliferative parameter could be a better way of studying the kinetics of (BMPC) in MGUS and MM than determining the BUDR-LI, since a wider range of values is obtained and this allows patient groups with different clinical characteristics to be separated more easily.

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The study suggests that 20% BMPC can be taken as a safe cut-off point at which to differentiate MGUS from early MM and outlines a few simple parameters which can be of diagnostic aid.