Multiple myeloma involves all of the red bone marrow and is widespread when the diagnosis is made. Consequently, there is no adjuvant or neoadjuvant treatment and no therapy for metastatic disease.
Not all patients who meet the minimal criteria for diagnosis of multiple myeloma should be treated. Because the disease is not curable and therapy causes potential side effects and involves cost, treatment should be delayed until there is evidence of progression , symptoms appear or treatment is needed to prevent complications.
When symptoms do develop, chemotherapy is the preferred treatment.
Chemotherapy The major controversy in chemotherapy is whether treatment should be with a
single alkylating agent such as melphalan (Alkeran) together with prednisone or a combination of alkylating agents .
Melphalan + prednisone is given daily by mouth for four to seven days every four to six weeks. This produces an objective response in 50 to 60 percent of patients. The dosage of melphalan must be changed depending upon the white cell count and platelet count, with the dosage increased to the point that some decrease in the white count or platelets occurs three weeks after the start of each cycle of therapy.
Many combinations of chemotherapy drugs—including melphalan, cyclophosphamide , carmustine (BCNU), vincristine , doxorubicin (Adriamycin) and prednisone—produce an objective response in about 70 percent of
