Cisplatin, BCNU, cyclophosphamide, and prednisone in multiple myeloma

Using the MOPC 104E murine plasmacytoma model, Ghanta et al have shown major synergism when cisplatin was added to a treatment program with BCNU and cyclophosphamide (CTX). To evaluate possible synergism in the treatment of human multiple myeloma (MM), 23 evaluable patients who had relapsed with standard treatment were treated with cisplatin, BCNU, CTX, and prednisone. There were five good and four fair responses in this group of heavily pretreated patients. These included responses in four patients who had failed to respond to or had relapsed with BCNU, CTX, and prednisone therapy at higher doses than those used in this protocol, indicating that there is synergism from the addition of cisplatin in the treatment of human MM. Gastrointestinal toxicity was significant but acceptable. Transient renal and hematologic toxicity was also seen. The number of responses and the apparent synergism seen suggest that this combination of drugs should be studied as therapy for untreated patients with MM, especially those with poor prognostic features.