Comparison of vincristine, carmustine, melphalan, cyclophosphamide, prednisone (VBMCP) and interferon-alpha with melphalan and prednisone (MP) and interferon-alpha (IFN-alpha) in patients with good-prognosis multiple myeloma: a prospective randomized study

Objectives. The purpose of the study was to evaluate, in a selected group o f myeloma patients with favorable prognosis, the effect, on response and su rvival, of polychymotherapy compared with melphalan prednisone. plus interf eron in both arms. Methods: Eighty-nine previously untreated patients with multiple myeloma and prognostic factors indicating a good prognosis were ra ndomized to either oral melphalan plus prednisone (MP) in combination with recombinant interferon-alpha (rIFN-alpha) or combination chemotherapy with vincristine, carmustine, melphalan, cyclophosphamide, and prednisone (VBMCP ) alternating with rIFN-alpha. The two treatment groups were comparable in terms of pretreatment characteristics. Results. The overall response rate w as 67.4% (2.3% complete remission, 65.1% partial response) in the MP/IFN-al pha group and 69.1% (14.3% complete remission, 54.8% partial response) in t he VBMCP/IFN-alpha group (p = 0.59). There were no differences also in resp onse duration and overall survival between the two treatment groups. The me dian response duration was 39.1 months in the MP/IFN-alpha group and was no t reached in the VBMCP/IFN-alpha group (p = 0.6). Overall survival was long ill both treatment groups. The estimated 5-yr survival was 66% and 62% in the MP/IFN-alpha and VBMCP/IFN-alpha group, respectively (p = 0.8). Toxicit y was modest and treatments were well tolerated. Neutropenia (WHO grade 3 o r 4) was higher, but not statistically significant, in the VBMCP/IFN-alpha group. Conclusions: The results of the study show that in myeloma patients with good prognosis, combination chemotherapy alternating with interferon-a has no advantage over conventional MP plus interferon-alpha, in regard to response rate, response duration, and overall survival of patients.