Management of Myeloma: Current and Future Approaches.
BACKGROUND: The treatment of multiple myeloma, relatively stagnant for many years, appears to be entering a promising era for improvement. This paper reviews treatment interventions available for patients with multiple myeloma to indicate a standard approach and to evaluate the spectrum of current standard therapy. METHODS: The author reviews published literature on the treatment of multiple myeloma. Both journal articles and papers presented at national and international meetings are utilized. RESULTS: Intensive combination chemotherapy offers relatively modest improvement over standard melphalan plus prednisone, but the use of interferon for maintenance therapy lengthens response duration and possibly survival. High-dose chemotherapy with stem-cell transplantation is a relatively safe and effective treatment modality for patients under 70 years of age at first relapse. Studies in progress will determine its role in first response consolidation. Use of hematopoietic growth factors, prophylactic antibiotics, and bisphosphonate treatment of lytic bone disease has diminished disease morbidity. CONCLUSIONS: While cure of multiple myeloma remains elusive and 10-year survival is still uncommon, newer treatment approaches offer better control of disease manifestations and perhaps a real opportunity to prolong functional life. Future treatments that will address minimal residual disease may improve long-term survival.
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Virginia Piper Cancer Institute, Northwestern Hospital, Minneapolis, Minnesota 55407-3799, USA.