Dose-intensive melphalan with stem cell support (MEL100) is superior to standard treatment in elderly myeloma patients

A clinical relationship between dose-intensity of melphalan and response ra te has been demonstrated in multiple myeloma. Promising results have been r eported after 200 mg/m(2) melphalan, especially in younger patients. It is uncertain whether 100 mg/m(2) melphalan (MEL100) can offer similar results in older patients. To address this issue, patients were treated with 2 or 3 MEL100 courses followed by stem cell support. Seventy-one patients (median age, 64 years) entered the protocol at diagnosis. Their clinical outcome w as compared with that of 71 pair mates (median age, 64 years) selected from patients treated at diagnosis with oral melphalan and prednisone (MP) and matched for age and beta 2-microglobulin, Complete remission was 47% after MEL100 and 5% after MP. Median event-free survival was 34 months in the MEL 100 group and 17.7 months in the MP group (P < .001), Median overall surviv al was 56+ months for MEL100 and 48 months for MP (P < .01). In a multivari ate analysis, beta 2-microglobulin levels and MEL100 were independent risk factors associated with outcome: superior event-free and overall survival w ere observed in patients presenting low pa-microglobulin levels at diagnosi s and receiving MEL100 as induction regimen. In conclusion, MEL100 was supe rior to MP in terms of complete remission rate, event-free survival, and ov erall survival, (C) 1999 by The American Society of Hematology.