High-dose melphalan for multiple myeloma: long-term follow-up data.
OBJECTIVE
To present long-term follow-up data of patients with myeloma treated with high-dose melphalan HDM, including an assessment of prognostic factors.


METHODS
Between November 1981 and April 1986, 63 previously untreated patients with multiple myeloma received HDM 140 mg/m2 without autologous bone marrow transplantation.


RESULTS
The overall response rate was 82% (51 of 62), with 32% (20 of 62) patients entering complete remission (CR). The median duration of response was 18 months, and six patients remain alive and free from disease progression at 60+ to 84+ months. Improvements in quality of life associated with remission were immediate in terms of pain grade (89% of patients) and performance status (92%), and later in terms of bone healing (29%). Currently, at a median follow-up duration of 74 months (range, 63 to 100) since HDM, 23 patients are alive with a median survival duration of 47 months, and 35% of patients are expected to be alive at 9 years. Apart from early-stage disease, no factors were found to predict long-term survival. No second malignancies or other late side effects have been recorded.


CONCLUSIONS
Single-agent HDM without autologous bone marrow transplantation is a feasible therapeutic option in myeloma, and is associated with a high objective response rate, relatively long remission durations, and good symptom control.
Cunningham
D
D
Cancer Research Center Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
Paz-Ares
L
L
Gore
M E
ME
Malpas
J
J
Hickish
T
T
Nicolson
M
M
Meldrum
M
M
Viner
C
C
Milan
S
S
Selby
P J
PJ
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D011379:Prognosis; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome
D008558:Melphalan