Treatment of multiple myeloma according to the extension of the disease: a prospective, randomised study comparing a less with a more aggressive cytostatic policy

Abstract

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,

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

“…Prognostic models for predicting asymptomatic MM progression, 8,12,15 including the model described in the current study, would allow the identification of low-risk patients who harbor a very indolent disease similar to MGUS and high-risk patients who might benefit from close follow-up and who may be optimal candidates for experimental therapies aimed at delaying the progression of MM. [35][36][37][38][39][40][41] …”

Relevance of age on survival of 341 patients with multiple myeloma treated with conventional chemotherapy: updated results of the MM87 prospective randomized protocol

“…Between January 1987 and March 1990, 341 patients with previously untreated MM entered the prospective, multicentre, randomized Protocol MM87 (Riccardi et al, 1994). …”

“…Patients with stage II disease were uniformly treated with MPH-P. Response was according to slightly modified clinical criteria adopted by the SECSG (Cohen et al, 1979), as detailed elsewhere (Riccardi et al, 1994). Response was evaluated after six courses of MPH-P or four courses of PTC-VCR-P.…”

“…the plateau phase) was achieved (Riccardi et al, 1994) and then stopping all cytostatics until relapse or continuing therapy indefinitely until relapse, as a maintenance.…”

“…A typical series of patients with multiple myeloma (MM) has a median age of about 65 years and survive a median time of about 3 years when treated with conventional chemotherapy (CT) (Alexianan et al, 1969;Sporn et al, 1986, Osteborg et al, 1989Riccardi et al, 1994).…”