THE PROGNOSIS OF MULTIPLE-MYELOMA ON CURR ENT CHEMOTHERAPY HAS NOT IMPROVED OVER THE LAST 20 YEARS

The treatment of multiple myeloma has changed over the last 20 years. We investigated the effects of theses changes on patient survival in t he current practice of a rheumatology ward. Two hundred and seventy-ni ne patients were hospitalised between 1972 and 1993: 30 from 1972 to 1 976, 70 from 1977 to 1981, 86 from 1982 to 1986, 75 from 1987 to 1991 and 18 from 1992 to 1993. Staging according to Durie and Salmon was I in 8%, II in 29% and III in 65%. In principle, the initial therapy was monochemotherapy in 65% of the cases and polychemotherapy in 35%. Ar the time of the present study, 197 patients have died. The actuarial c urves of survival were similar in all historical classes defined by th e date of first admission. Curves of median of follow-up and of floati ng means were level between 1972 and 1990. No correlation was found be tween the date of first admission and survival in the 174 patients who died between 1972 and 1987. The following parameters were associated with longer survival: achievement of an objective response on chemothe rapy, lower patient's age, high haemoglobin low creatinine, low stage according to Durie and Salmon, low number of plasma cells in bone marr ow, low calcemia and low levels of lgA, monoclonal component. The comp arison of prognosis factors in historical classes showed a difference only for haemoglobin which was lower in the earlier class. The type of the first chemotherapy regimen varied widely between historical class es. The number of responders was significantly greater after polychemo therapy than after monochemotherapy bur no correlation was observed be tween the type of chemotherapy and survival. The frequencies of early death, and the causes of death in general were not different in the hi storical classes. The lack of improvement of survival over the last 20 years shows that the efficacy of current chemotherapies is limited, a conclusion which warrants the exploration of other therapeutic avenue s.