COMPARATIVE SURVIVAL, QUALITY-OF-LIFE AND COST-EFFECTIVENESS OF INTENSIVE THERAPY WITH AUTOLOGOUS BLOOD-CELL TRANSPLANTATION OR CONVENTIONAL CHEMOTHERAPY IN MULTIPLE-MYELOMA

We retrospectively compared survival time, quality of life, and the th erapy costs in 37 patients suffering from newly diagnosed multiple mye loma (MM), divided into 3 groups, Twelve patients with grade III MM, a ccording to the classification of Durie-Salmon, all with widespread ly tic lesions (group I), underwent a two-phase intensive therapy, They f irst received high-dose melphalan (HDM), both as tumor-reducing and bl ood cell (BC)-mobilizing chemotherapy, subsequently followed by BC tra nsplantation. Group II comprising 10 patients, also with grade III MM and with characteristics similar to those of group I, were treated wit h conventional polychemotherapy, Finally, group III enrolled 15 patien ts with lower grade disease (grade II) who were also treated with conv entional chemotherapy, The median overall survival time and the qualit y of life index were significantly lower in group II than in group I ( P = 0.0013 and <0.001 respectively), Although the overall survival tim e of group III (43 months) was similar to that of group I, its quality of life index was also significantly lower (P < 0.05), However, the t otal therapy costs of group I were globally higher than those of the 2 other groups, but when absolute cost-effectiveness as well as qualita tive cost-effectiveness (corrected for quality of life) were analyzed, the costs per week of life gained of group I compared extremely favor ably with those of group II and, to a lower degree, of group III, Inte nsive therapy therefore seems capable of substantially improving the s urvival time for high-risk MM patients with satisfactory quality of li fe and at a reasonable cost.