CLINICAL-EVALUATION OF RESPONSE OR ESCAPE TO CHEMOTHERAPY AND OF SURVIVAL OF PATIENTS WITH MULTIPLE-MYELOMA - A PROSPECTIVE-STUDY OF 202 PATIENTS (1975-1982)

Abstract

From 1975-1982, 202 previously untreated patients with multiple myeloma (MM) and clinical evidence of disease progression received intensive chemotherapy every 3-5 wk to induce remission. Treatment regimen included intermittent courses of a combination of cycle non-specific drugs (melphalan, cyclophosphamide) plus vincristine and prednisone, with or without adriamycin. Several other drugs having some efficacy in MM were used in case of primary treatment failure or in relapse. The overall median survival was 29 mo., with an 8-yr actuarial death-rate (related to MM) equal to 75%. Of the patients 40% had disease progression and short survival (median = 9 mo., early deaths included). Of the patients, 50% had stable or regressive disease (.gtoreq. 50 < 99% cell mass regression) and a dramatic improvement of survival (4 yr survival rate = 50% vs. 0% for refractory MM, P < 10-9). The best remission, (i.e., disappearance of the monoclonal protein, defined as > 99% regression and 100% of .gtoreq. 1 yr plateau) with the longest survival achieved 10% (4 yr survival rate = 80%, P < 0.02). In patients achieving a .gtoreq. 75% regression and a 1 yr plateau, the remission duration was not shortened in off-treatment patients. Three types of relapse with a major influence on survival were observed: smoldering (13%), slow (49%) and fulminant (38%).