The standard treatment for patients with stage II and III newly diagnosed multiple myeloma is chemotherapy induction followed by a single high-dose chemotherapy treatment and autologous stem cell support. Even with this treatment, the complete response rate is approximately 30-35%. Several groups of physicians have evaluated the potential benefit of using 2 cycles of high-dose chemotherapy with autologous stem cell support for patients with multiple myeloma.
Physicians in France performed a clinical trial in which 402 newly diagnosed patients with multiple myeloma were treated with either one cycle of melphalan chemotherapy and total body irradiation or one cycle of high-dose melphalan and one cycle of melphalan and total body irradiation supported by autologous peripheral blood stem cells.
Overall, 85% of patients received the first cycle of high-dose chemotherapy and 78% received both cycles of treatment. The complete remission rate was 39% with 1 cycle of treatment and 49% after 2 cycles of treatment. However, there were no differences in survival between the 2 groups of patients. Good risk patients as evidenced by a low beta 2 microglobulin experienced a 3-year survival of 84% if treated with 2 cycles of treatment compared to 69% for those receiving only 1 cycle of high-dose chemotherapy treatment.
While this study needs additional follow-up for definitive analysis, it suggests that 2 cycles of treatment is of significant benefit to patients who already have a reasonably good outcome, but may not improve the outcomes for patients with more aggressive disease. Different high-dose treatment regimens are currently being evaluated and may be more effective than the ones chosen for this study. (
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Blood, Vol 94, No 10, Suppl 1, Abstract 3152, pp 714a, 1999)
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