EVOLUTION OF MULTIPLE-MYELOMA TREATMENT FROM MELPHALAN MONOTHERAPY TOBONE-MARROW TRANSPLANTATION

Melphalan has brought the first improvement in the therapy of multiple myeloma at the beginning of the sixties. The median of survival was p rolonged from several months to 3 years. In the following 3 decades ne w drugs were tested, but no other drug brought better results than mel phalan. The comparative studies have proved, that therapy response has been reached more rapidly after polychemotherapy than after monothera py, but none of the treatment modalities differed in the survival para meters. The significance of interferon alpha for the treatment of mult iple myeloma has been tested since the beginning of the eighties. Many clinical trials have brought controversial results. The latest metaan alysis and data published support the indication of interferon alpha f or the multiple myeloma maintenance treatment. Important progress in t he therapy of multiple myeloma has been done in the nineties. High dos es of alkylating cytostatics with the support of autologous peripheral blood stem cells transplantation or bone marrow transplantation enhan ced the number of therapy-responses and prolonged the survival. The re sults of autologous transplantations are so favourable, that this proc edure can be recommended as the first line treatment in suitable patie nts. Allogenic bone marrow transplantation is linked with many complic ations and therefore this method will be performed only in a limited n umber of patients.