HIGH-DOSE CHEMOTHERAPY IN MULTIPLE-MYELOMA

The median survival of conventionally treated patients with multiple m yeloma is 3 years. Modifications of conventional chemotherapy have fai led to show an improved survival rate in most randomized trials. Thera py regimens with dose-escalated alkylating agents (ie melphalan) have induced higher remission rates in comparison to conventional treatment modalities. With the support of autologous or allogeneic hematopoieti c progenitor cells, it has been possible to reduce the hematoxicity of these dose-escalated treatments. The transplantation of autologous pe ripheral blood progenitor cells results in faster hematopoietic recons titution with decreased high-dose therapy-related morbidity compared t o autologous bone marrow. The randomized French myeloma trial and the pair-mate analysis of the results of the 'total therapy' including dou ble autografting of the Barlogie group with data from the South Wester n Oncology Group (SWOG) showed a significant survival advantage for pa tients following autologous transplantation. Although a graft-versus-m yeloma effect was described, the benefit of high-dose treatment with a llogeneic transplantation is less clear, mainly due to the high transp lantation-related mortality rate. In this paper, results of transplant ation trials are summarized. Prognostic factors and future treatment m odalities for myeloma are discussed.