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Treatment for Multiple Myeloma: Title and subTitle BreakCombination Chemotherapy With Different Melphalan Dose Regimens FREE

Raymond Alexanian, MD; Arthur Haut, MD; Asad U. Khan, MBBS; Montague Lane, MD; Eugene M. McKelvey, MD; Philip J. Migliore, MD; W. J. Stuckey, Jr., MD; Henry E. Wilson, MD
[+] Author Affiliations

Reprint requests to 6723 Bertner Ave, Houston 77025 (Dr. Alexanian).


JAMA. 1969;208(9):1680-1685. doi:10.1001/jama.1969.03160090040009
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Of 183 patients with multiple myeloma treated with melphalan, 43% demonstrated an objective response. Of the evaluable cases, 70% of the patients responded to combination therapy with melphalan and prednisone, 35% to intermittent melphalan therapy, and 19% to daily melphalan therapy. Symptomatic manifestations of disease decreased in almost all responding patients. The degree of remission was superior with melphalan-prednisone therapy since serum myeloma globulin peaks disappeared more frequently from the electrophoresis scan. In patients producing only λ Bence Jones proteins, azotemia was more frequent, the incidence of response was low, and survival was short. Median survival for patients treated with melphalan-prednisone was about six months longer than the survival of patients treated with melphalan alone. Results support the use of intermittent courses of concurrent chemotherapy with large doses of melphalan and prednisone in patients with multiple myeloma.

REFERENCES

Blokhin, N., et al:  Clinical Experiences With Sarcolysin in Neoplastic Diseases , Ann NY Acad Sci 68:1128-1132 ( (April) ) 1958;.
Bergsagel, D.E., et al:  The Treatment of Plasma Cell Myeloma , Advances Cancer Res 10:311-359, 1967;.
Alexanian, R., et al:  Melphalan Therapy for Plasma Cell Myeloma , Blood 31:1-10 ( (Jan) ) 1968;.
Hoogstraten, B., et al:  Melphalan in Multiple Myeloma , Blood 30:74-83 ( (July) ) 1967;.
Lane, M.:  Some Effects of Cyclophosphamide (Cytoxan) on Normal Mice and Mice With L-1210 Leukemia , J Nat Cancer Inst 23:1347-1359 ( (Dec) ) 1959;.
 New Treatment Schedule With Improved Survival in Childhood Leukemia, Acute Leukemia Group B , JAMA 194:75-81 ( (Oct 4) ) 1965;.
Carbone, P.P.; Kellerhouse, L.E.; and Gehan, E.A.:  Plasmacytic Myeloma , Amer J Med 42:937-948 ( (June) ) 1967;.
 Chronic Leukemia-Multiple Myeloma Task Force of the National Cancer Institute: Guidelines for Protocol Studies of Plasma Cell Myeloma , Cancer Chemother Rep , to be published.
Solomon, A.; Fahey, J.L.; and Malmgren, R.A.:  Immunohistologic Localization of Gamma-1-Macroglobulins, Beta-2A-Myeloma Proteins, 6.6 S. Gamma-Myeloma Proteins and Bence Jones Proteins , Blood 21:403-423 ( (April) ) 1963;.
Nathans, D.; Fahey, J.L.; and Potter, M.:  The Formation of Myeloma Protein by a Mouse Plasma Cell Tumor , J Exp Med 108:121-130 ( (July) ) 1958;.
Bergsagel, D.E.; Migliore, P.J.; and Griffith, K.M.:  Myeloma Proteins and the Clinical Response to Melphalan Therapy , Science 148:376-377 ( (April) ) 1965;.
Holland, J.F., et al:  A Controlled Trial of Urethane Treatment in Multiple Myeloma , Blood 27:328-342 ( (March) ) 1966;.
Lindström, F.D., et al:  Urinary Light-Chain Excretion in Myeloma and Other Disorders: An Evaluation of the Bence Jones Test , J Lab Clin Med 71:812-825 ( (May) ) 1968;.
Costa, G., et al:  Prednisone and L-phenylalanine Mustard (L-Pam): An Effective Combination in the Treatment of Multiple Myeloma in Man , abstracted, IXth International Cancer Congress, Tokyo, October, 1966 .
Frei, E., III, et al:  A Comparative Study of Two Regimens of Combination Chemotherapy on Acute Leukemia , Blood 13: 1126-1148 ( (Dec) ) 1958;.
Moxley, J.H., III, et al:  Intensive Combination Chemotherapy and X-Irradiation in Hodgkin's Disease , Cancer Res 27: 1258-1263 ( (Nov) ) 1967;.
Salmon, S.E.; Shadduck, R.K.; and Schilling, A.:  Intermittent High-Dose Prednisone (NSC-10023) Therapy for Multiple Myeloma , Cancer Chemother Rep 51:179-187 ( (June) ) 1967;.

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Blokhin, N., et al:  Clinical Experiences With Sarcolysin in Neoplastic Diseases , Ann NY Acad Sci 68:1128-1132 ( (April) ) 1958;.
Bergsagel, D.E., et al:  The Treatment of Plasma Cell Myeloma , Advances Cancer Res 10:311-359, 1967;.
Alexanian, R., et al:  Melphalan Therapy for Plasma Cell Myeloma , Blood 31:1-10 ( (Jan) ) 1968;.
Hoogstraten, B., et al:  Melphalan in Multiple Myeloma , Blood 30:74-83 ( (July) ) 1967;.
Lane, M.:  Some Effects of Cyclophosphamide (Cytoxan) on Normal Mice and Mice With L-1210 Leukemia , J Nat Cancer Inst 23:1347-1359 ( (Dec) ) 1959;.
 New Treatment Schedule With Improved Survival in Childhood Leukemia, Acute Leukemia Group B , JAMA 194:75-81 ( (Oct 4) ) 1965;.
Carbone, P.P.; Kellerhouse, L.E.; and Gehan, E.A.:  Plasmacytic Myeloma , Amer J Med 42:937-948 ( (June) ) 1967;.
 Chronic Leukemia-Multiple Myeloma Task Force of the National Cancer Institute: Guidelines for Protocol Studies of Plasma Cell Myeloma , Cancer Chemother Rep , to be published.
Solomon, A.; Fahey, J.L.; and Malmgren, R.A.:  Immunohistologic Localization of Gamma-1-Macroglobulins, Beta-2A-Myeloma Proteins, 6.6 S. Gamma-Myeloma Proteins and Bence Jones Proteins , Blood 21:403-423 ( (April) ) 1963;.
Nathans, D.; Fahey, J.L.; and Potter, M.:  The Formation of Myeloma Protein by a Mouse Plasma Cell Tumor , J Exp Med 108:121-130 ( (July) ) 1958;.
Bergsagel, D.E.; Migliore, P.J.; and Griffith, K.M.:  Myeloma Proteins and the Clinical Response to Melphalan Therapy , Science 148:376-377 ( (April) ) 1965;.
Holland, J.F., et al:  A Controlled Trial of Urethane Treatment in Multiple Myeloma , Blood 27:328-342 ( (March) ) 1966;.
Lindström, F.D., et al:  Urinary Light-Chain Excretion in Myeloma and Other Disorders: An Evaluation of the Bence Jones Test , J Lab Clin Med 71:812-825 ( (May) ) 1968;.
Costa, G., et al:  Prednisone and L-phenylalanine Mustard (L-Pam): An Effective Combination in the Treatment of Multiple Myeloma in Man , abstracted, IXth International Cancer Congress, Tokyo, October, 1966 .
Frei, E., III, et al:  A Comparative Study of Two Regimens of Combination Chemotherapy on Acute Leukemia , Blood 13: 1126-1148 ( (Dec) ) 1958;.
Moxley, J.H., III, et al:  Intensive Combination Chemotherapy and X-Irradiation in Hodgkin's Disease , Cancer Res 27: 1258-1263 ( (Nov) ) 1967;.
Salmon, S.E.; Shadduck, R.K.; and Schilling, A.:  Intermittent High-Dose Prednisone (NSC-10023) Therapy for Multiple Myeloma , Cancer Chemother Rep 51:179-187 ( (June) ) 1967;.
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