Treatment of multiple myeloma

New drugs raise hope for the future

Multiple myeloma is a malignant disease of plasma cells that is characterised by secretion of paraprotein, humoral immunodeficiency, anaemia, lytic bone lesions, and kidney dysfunction. Although the median survival of patients with multiple myeloma has improved from seven months to five years with treatment, the disease remains largely incurable.1

Conventional treatment includes melphalan and prednisone, now used sparingly because of its propensity to compromise collection of haematopoietic stem cells, other combinations, and regimens containing high dose corticosteroids. The latter—including dexamethasone; vincristine, doxorubicin, and dexamethasone; and cyclophosphamide, vincristine, doxorubicin, and methylprednisolone—are preferred for induction because of their excellent anti-myeloma activity and lack of marrow toxicity.

High dose chemotherapy, particularly melphalan, with autologous haematopoietic stem cell transplantation improves response rates and their duration and survival compared with conventional chemotherapy. It is now commonly used as consolidation treatment.1 The superiority of consolidation with haematopoietic stem cell transplantation over continued conventional treatment has been confirmed in two randomised studies with a 12 month increase in median overall survival.2 3 Another study has shown …