Dose intensity analysis of melphalan and prednisone in multiple myeloma

The average relative dose intensity (DI) of conventional oral melphalan and prednisone therapy received by 93 newly diagnosed multiple myeloma patients was correlated with survival and with percent reduction in M-protein. A survival advantage was shown with increasing average relative DI of melphalan and prednisone. Multivariate analysis showed survival to correlate with increasing DI of prednisone (P = .05) but not with the DI of melphalan (P = .93) nor with the percent decrement in M-protein (P = .10). These results suggest that the initial management of myeloma should be reassessed, with particular emphasis on more intensive therapy employing high-dose steroids.