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.