The Chemotherapy of Plasma-Cell Myeloma and the Incidence of Acute Leukemia

Abstract

Previously untreated patients with myeloma were randomized to initial treatment with melphalan and prednisone (and to cyclophosphamide or carmustine if relapse or progression occurred) (Group A, 125 patients), melphalan, cyclophosphamide, carmustine and prednisone in alternating (Group B, 123 patients) or concurrent (Group C, 116 patients) schedules. The groups were similar with respect to known prognostic factors. Response rates and survival were also similar. We were unable to identify a subgroup of patients who responded or survived better on melphalan-cyclophosphamide-carmustine and prednisone than on melphalan and prednisone. We conclude that the combination of the four drugs is not better than melphalan and prednisone for inducing responses or prolonging the survival of patients with myeloma. Myelomas producing only λ chains have a poorer prognosis (P<0.01) than IgG, IgA, or κ myeloma. Acute leukemia has developed in 14 patients. The actuarial risk of developing acute leukemia has increased rapidly to 17.4 per cent at 50 months. (N Engl J Med 301:743–748, 1979)