title: Results of therapy and changing prognosis of multiple myeloma during the last 40 years in the region of North and Middle Moravia: group of 562 patients.
abstract: BACKGROUND
  The aim of this study was the retrospective assessment of therapy results and the changing prognosis of multiple myeloma (MM) patients from the Middle and North Moravia region of the Czech Republic during the last 40 years.
  
  
  METHODS
  The analyzed group of 562 patients was gathered in the years 1959-2000, mean age 63 (28-91) years, M/F ratio 1.1 : 1.0. Overall survival (OS) curves were plotted according to the method of Kaplan and Meier and compared using the log rank test (P<0.05).
  
  
  RESULTS
  During the long assessed period, a significant change in prognosis and therapy response was achieved (P=0.0000). The 'first turning point' (1963-1975) characterized by unsystematic melphalan and prednisone therapy (MP), led to significant improvement of OS (8-19 months, P=0.0031) in comparison with the period of plain symptomatic therapy (1959-1963) and the increase in 3-year survival rate from 4 to 23% of patients. The 'second turning point' (1976-1980), characterized by introduction of the systematic conventional polychemotherapy (VMP, VMCP, VBAP, VCAP) and complex supportive treatment, was associated with subsequent improvement of therapeutic response (OS 40 months, P=0.0000; 3- or 10-year survival was seen in 55 and 5.5% of patients). Nevertheless, the results of the next 20 years (regimens VB(C)MCP, VAD, Cy-VAD and CIDEX) are a little disappointing with insignificant progress. In the whole group of 295 patients from the years 1976 to 1995, divided into 5-year periods, remission (R< or =25% of the initial M-protein level) was achieved in 10-24% of cases, the OS median was 32-44 months, and 5 (respectively 10)-year survival improved from 25 to 36% and from 5.5 to 16.5% of patients. The 'third turning point' represented years 1996-2000 marked with the introduction of high dose (HD)-therapy with ASCT support leading in a group of 31 patients (< or =65 years) to remission in 71%, to complete remission in 32% and to significant improvement of OS (P=0.0037) and 5-year survival in 91% of the patients. The improvement of therapy results in this 'third turning point' was demonstrated in comparison with the 1976-1995 group with conventional therapy with a group of patients from 1996 to 2000 (both conventional and HD therapy with ASCT), characterized by 36% of remissions and 5-year survival of 57% of the patients (P=0.030). HD therapy with ASCT achieved in the years 1996-2000 had better therapy results (R-71%, 5-year survival 91%) than that achieved in two comparable groups of patients (1991-1995 and 1996-2000), fulfilling all criteria of HD therapy with ASCT but treated with conventional therapy only (R - 24 and 32%, 5-year survival 46 and 68% of the patients).
  
  
  CONCLUSIONS
  The retrospective analysis showed that the meaningful change in overall prognosis of MM patients achieved in Moravia is in accord with worldwide trends in the course of 1959-2000 years, which was achieved due to the gradual application of the modern innovated systems of complex therapy.
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D018153:Czech Republic; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome