Multiple myeloma treated with high dose intravenous melphalan

Area of Science:

• Hematology
• Oncology
• Clinical Pharmacology

Background:

• Multiple myeloma is a hematologic malignancy characterized by uncontrolled proliferation of plasma cells.
• Current treatment strategies for multiple myeloma aim to induce remission and prolong survival.

Purpose of the Study:

• To evaluate the efficacy and safety of high-dose melphalan (HDM) in patients with multiple myeloma.
• To assess the impact of adding high-dose methylprednisolone to HDM therapy.

Main Methods:

• A study involving 58 patients under 63 years with multiple myeloma treated with HDM (140 mg/m2 i.v.).
• A subsequent study added high-dose methylprednisolone (1 g/m2 daily for 5 d) to HDM.
• Patient response was assessed by complete remission (CR) and partial remission (PR) criteria.

Main Results:

• In previously untreated patients, HDM achieved 27% CR and 51% PR, with a median remission duration of 19 months.
• In patients who failed prior chemotherapy, the response rate was 66%, but all relapsed within 1 year.
• Adding methylprednisolone to HDM showed similar response rates with a significant reduction in early deaths.

Conclusions:

• HDM is an effective treatment for multiple myeloma, inducing significant remission rates.
• HDM is associated with substantial toxicities, including myelosuppression and gastrointestinal side effects.
• Further research, including a prospective MRC trial, is warranted to compare HDM with and without steroids against conventional therapy.