patients. But the average survival of those treated with the single alkylating agent (melphalan) and those receiving multiple alkylating agents is about the same—two to three years.

    Chemotherapy should be continued until the patient responds and is in a stable (plateau) state. This usually requires one to two years of therapy. Treatment with alkylating agents should not be given after reaching the plateau state because they may damage the bone marrow , resulting in a myelodysplastic syndrome or acute leukemia. Alpha2-interferon (alpha2-IFN) will prolong the plateau state, but the overall survival is probably the same as for those to whom no maintenance therapy is given. The dosage of  alpha2-IFN must be altered so that the side effects do not interfere with the patient's well-being. Patients must be followed closely, however, and chemotherapy must be started again when there is a relapse. Most patients will again respond to the same treatment that they received initially.

               Radiation  The use of radiation therapy should be limited to those patients with disabling  pain who
               have a local process that has not responded to chemotherapy. The use of Tylenol with codeine or other narcotics can usually control the pain. This approach is preferred to local radiation because pain frequently recurs in another site anyway and local radiation does not benefit anyone with generalized disease.