Prognostic value of bone marrow plasma cell infiltration in stage I multiple myeloma

We analysed for prognosis and response to chemotherapy a series of 48 consecutive stage I myeloma patients who were treated with melphalan and prednisone soon after diagnosis. It was found that the extent of bone marrow plasma cell infiltration had prognostic value, the survival of the patients with more than 50% plasma cells being significantly shorter (P less than 0.005) than that of the patients with less than 50% plasma cells. In the latter group, the observed number of deaths was so small (two cases) as to preclude any further analysis. In contrast, in the former group, a significant relationship between the response to chemotherapy and patients' survival (P less than 0.001) was demonstrated. We conclude that a prospective randomized trial of treatment versus no treatment is warranted in stage I patients who have a high risk of death (i.e. with a high bone marrow plasma cell infiltration) in order to establish whether chemotherapy prolongs the length of survival.