A randomized trial of melphalan and prednisone versus melphalan, prednisone, cyclophosphamide, MeCCNU, and vincristine in untreated multiple myeloma.

Abstract

In a randomized study with 234 previously untreated patients with multiple myeloma, 129 were treated with melphalan (8 mg/m2 perorally for four days) and prednisone (40 mg/m2 perorally for seven days, both every four weeks) and 105 with melphalan and prednisone at the same doses plus cyclophosphamide (600 mg/m2 intravenously every four weeks), MeCCNU (100 mg/m2 PO every eight weeks), and vincristine (MPCCV, 0.6 mg/m2 IV every four weeks). A total of 49 (38%) of the 129 patients treated with melphalan and prednisone (MP) and 48 (46%) of the 105 patients treated with MPCCV showed good response (GR) (P not significant); the overall response rates were 58% and 70%, respectively. Thirty-seven percent of the MP group and 39% of the MPCCV group remain alive at 48 months from first treatment (P not significant). The estimated 48-month survival from first treatment, according to different prognostic factors at diagnosis, in both groups was as follows: stage 1,56%; stage II, 46%, and stage III, 23% (I and II v III P less than .001). Survival at 48 months according to response was GR, 68%; partial response (PR), 33%; and null, 16% (GR v null, P less than .0005; GR v PR, P less than .0005). Survival according to renal function was 43% for a creatinine level less than 2 mg/100 mL and 27% for a creatine level greater than or equal to 2 mg/100 mL (P less than .0005). No significant difference has been found between the two treatment schedules in terms of response rate and survival time, in any stage of disease.

Combination Chemotherapy for Multiple Myeloma with BCNU, Cyclophosphamide, Vincristine, Melphalan, and Prednisone (M-2 Protocol)

“…There continues to be a controversy regarding the optimal therapy of myeloma; however, a number of recent publications seem to confirm the results of the M-2 or similar programs especially in stage III pa tients [14][15][16][17][18]. Other prospective trials have not shown any benefit of combination therapy in myeloma [10,25], The present data confirm the earlier published Memorial Sloan-Kettering M-2 results. The present study demonstrates a response rate of 90% in 54 previously untreated patients with stages II and III disease.…”

Randomized trial of ?-interferon or dexamethasone as maintenance treatment for multiple myeloma

“…Many treatments have been effective in newly diagnosed patients with MM, including combinations of one or more alkylating agents with a glucocorticoid, the VAD regimen, or intermittent dexamethasone alone [1][2][3][4][5][6]. Among comparable patients, the response rate with VAD was approximately 15% higher than that with dexamethasone, but survival times were similar and VAD was associated with more toxicity [4].…”

“…Many treatments have been useful for patients with multiple myeloma (MM). Several studies have shown no advantage for combinations of multiple alkylating agents with or without a glucocorticoid, in comparison with melphalan-prednisone [1][2][3]. Vincristine-doxorubicin by continuous infusion with intermittent dexamethasone (VAD) has not improved the survival of newly diagnosed patients [4].…”

High‐dose chemoradiotherapy with syngeneic bone marrow transplantation for multiple myeloma: A case report and literature review

“…Radiation therapy is used to augment chemotherapy when bone or other local lesions produce symptoms. Recently, combination chemotherapy has been evaluated with results that are not significantly different from standard therapy [10,11].…”