title: Prognostic factors with high-dose melphalan for refractory multiple myeloma.
abstract: High doses of melphalan (HDM) and dexamethasone were administered to 43 patients with advanced multiple myeloma, 36 of whom were refractory to both standard melphalan-prednisone and vincristine-adriamycin-dexamethasone (VAD). Forty-four percent responded with greater than 75% reduction in calculated tumor mass, including three patients who achieved a complete remission. The response rate to HDM was 56% in 18 relapsing patients and 50% in 12 patients with less than 12 months of primary drug resistance, but it was only 23% among the remaining 13 unresponsive patients. A high early mortality rate of 30% was confined to 26 patients with either poor performance (Zubrod greater than 1) or impaired renal function (creatinine greater than 1.4 mg%). When this toxic treatment was given to the 21 patients with good performance (Zubrod less than 2) whose disease lacked high serum lactic dehydrogenase (less than or equal to 500 U/L) as a recently recognized feature of high-grade myeloma, a superior median survival of 18 months was obtained as opposed to only 3 months for the 22 remaining patients (P less than .001). Thus, when employed in a timely fashion, HDM overcomes resistance to standard chemotherapy and VAD and benefits selected patients with advanced myeloma.
authors.affiliation: Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston.
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: R
authors.initials: R
authors.lastname: Alexanian
authors.forename: L
authors.initials: L
authors.lastname: Smallwood
authors.forename: B
authors.initials: B
authors.lastname: Cheson
authors.forename: D
authors.initials: D
authors.lastname: Dixon
authors.forename: K
authors.initials: K
authors.lastname: Dicke
authors.forename: F
authors.initials: F
authors.lastname: Cabanillas
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003907:Dexamethasone; D004317:Doxorubicin / Q000627:therapeutic use; D004341:Drug Evaluation; D004351:Drug Resistance; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan; D011241:Prednisone