MULTIPLE-MYELOMA

Multiple myeloma occurs in over 2000 new patients in England and Wales each year. It presents most frequently as bone pain and patients tend to become dehydrated and may develop renal failure. No available trea tment is curative, but about two thirds of patients achieve a stable r esponse with low dose combination chemotherapy. Combination chemothera py including doxorubicin and carmustinewith the alkylating agents cycl ophosphamide and melphalan achieve a higher stable response rate than conventional treatment with melphalan and prednisone without additiona l haematological toxicity. These responses are associated withloss of bone pain and patients remain symptom free for months without furthert reatment. Relapse occurs on average in a little under two years and, t hough second responses are frequently obtained, the disease eventually becomes refractory. This paper looks at who should be treated and the benefits that may be expected from the treatments available.