[Treatment of myeloma: role of intensive treatments]

  • Fermand J
  • Ravaud P
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Abstract

CURRENT SITUATION: Since the introduction of melphalan, little progress has be obtained in the treatment of multiple myeloma. Complete remission is rarely achieved with classical single-drug or combined chemotherapy protocols: median survival remains low at 2 to 3 years. A NEW APPROACH: High-dose melphalan therapy with hemopoietic stem cell support it a new approach providing promising results. There is a dose effect and 70 to 80% of naive patients, at the cost of severe prolonged aplasia, respond to high-dose melphalan. HEMATOPOIETIC SUPPORT: Allogeneic or autologous bone marrow or blood stem cell grafts are used. Peripheral blood autographs can be used in most patients; contamination with tumoural cells is generally lower. The period of aplasia after chemotherapy and hematopoietic autograft is relatively short. MAIN INDICATIONS: For most authors, high-dose melphalan should be reserved for younger patients with active myeloma: complete remission is achieved in 20 to 30% of cases although relapse still occurs. Other techniques under study (several sequences of high-dose sessions, reduction of graft contamination) should help improve results.

Author-supplied keywords

  • Antineoplastic Agents, Alkylating/therapeutic use
  • Bone Marrow Transplantation
  • Combined Modality Therapy
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Melphalan/therapeutic use
  • Multiple Myeloma/ therapy

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Authors

  • J P Fermand

  • P Ravaud

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