Does the Therapy According to Stage Improve Response and Survival in Multiple Myeloma Patients?

Abstract

The records of 104 patients (1972-80) with Multiple Myeloma (MM) were reviewed and a staging system was used dividing patients into Low Risk (LR) and High Risk (HR) groups, according to individual factors. Serum-calcium and serum creatinine, haemoglobin and the percentage of bone marrow plasma cells (BMPC), at the time of diagnosis, had predictive value on survival. This group of patients had already received treatment independent of these risk categories. Subsequently during 1980 to 1988, 114 evaluable patients with MM entered a prospective study using two treatment regimens according to that same staging system: LR patients were treated with Melphalan + Prednisone (MP) and HR patients with Vincristine, Melphalan, Cyclophosphamide and Prednisone (VMCP) for a minimum of six cycles. In the event of no response to the initial therapy given, a more aggressive regimen was then used: VMCP for LR patients and VAP or BAP (Vincristine or BCNU, Adriamycin, Prednisone) for the HR group for six to twelve cycles. The rate of response for Low and High Risk category was 42% and 73%, respectively. The median duration of response to initial therapy was 19 months for LR and 11 months for HR patients. Furthermore therapy chosen according to stage resulted in an improvement in survival compared to the earlier 1972-80 series. This was particularly significant for HR patients who benefited by an obvious decrease in the number of early deaths, due to progression of disease, when the combined regimens were used. The study indicates that therapy according to risk categories seems to be a worthwhile approach, MP being an appropriate initial treatment for LR while combination chemotherapy may be better for HR patients.