Controversy exists regarding the efficacy of various treatment schedules and drug combinations for patients with multiple myeloma. Fifty-three patients with this malignancy were evaluated. In a prospective program, 31 patients received a n intermittent combination drug schedule using melphalan and prednisone, and the results were compared to a group of 22 patients, studied retrospectively, who had been treated with continuous cyclophosphamide or melphalan administered to hematologic tolerance. Objective response occurred in 74% of those receiving the intermittent combination regimen compared to a 41% response rate for those receiving continuous alkylating agents. Eight patients who relapsed while on continuous alkylators were switched to the intermittent combination regimen, and three responded. Morbidity was not increased with intermittent combination drug program. EVERAL CHEMOTHERAPEUTIC AGENTS HAVE S been demonstrated to induce temporary remissions in multiple myeloma.4 When alkylating agents are employed, prolonged survival time has been shown to accompany clinical remission.11~~ Controversy regarding the efficacy of various therapeutic agents, treatment schedules, and drug combinations for this disease, however, c ~n t i n u e s . ~. ~J . ~J ~
The improvement in therapeutic index that accompanies multi-drug therapy for childhood leukemia1 has prompted trials of combined chemotherapy for multiple myeloma.8.7 During the past 2 years, we have employed a prospective combined drug program for treating patients with multiple myeloma and compared the results to a retrospective evaluation of patients who had received a continuously administered alkylating agent.
Methods
The study consisted of 53 patients who fulfilled the diagnostic criteria outlined by the Presented March 31. 1971, at the 52nd Annual Session of the American College of Physicians, Denver, Colo.