The use of intravenous intermediate dose melphalan and dexamethasone as induction treatment in the management of de novo multiple myeloma

The variable absorption of melphalan from the gastrointestinal tract result s in response rates between 40 and 60%. High dose melphalan increases respo nse rates but at the cost of increased morbidity and mortality. We have inv estigated intravenous intermediate dose melphalan and dexamethasone in the treatment of patients presenting with c-le novo multiple myeloma with the o bject of reducing toxicity while preserving an improved response rate compa red to oral melphalan and prednisolone. The results show that this treatmen t can be delivered safely on an outpatient basis in patients up to the age of 78 yr; 82% of patients achieved an objective response and 30% a complete haematological and clinical remission. Median overall survival for the who le group is 37 months.