Many drug combinations have been tested in the treatment of multiple myeloma , including drugs such as melphalan , cyclophosphamide , carmustine (BCNU), vincristine , doxorubicin and prednisone . An improved objective response rate has been reported for a few of these trials, but the median survival for those treated with melphalan and prednisone or the drug combinations is about the same, around two and a half years.
In patients who respond with stabilization of the M-protein, or a fall, and reduced pain, treatment should be continued until the M-protein reaches a plateau that is stable for four months. Even when the M-protein does not fall very much, patients with a stable M-protein survive just as well as those in whom the M-protein falls by more than 50 percent before reaching the plateau. Treatment with melphalan and prednisone will be required for 8 to 12 months to reach a stable plateau (remission). Continuing melphalan and prednisone beyond this point does not improve survival.
However, a recent Canadian trial of interferon-alpha as maintenance therapy for myeloma patients who achieved a stable plateau response with melphalan and prednisone showed that this therapy prolongs the duration of the remission and overall survival.
Remissions last for an average of 12 months after melphalan and prednisone are stopped (when no maintenance is used), but may last for more than five years. Patients are followed carefully after treatment so that chemotherapy can be reinstituted at the first sign of disease progression .
