• A combination of alkylating agents (vincristine + BCNU + melphalan + cyclophosphamide + prednisone
[VBMCP]) in alternating cycles with alpha2-interferon (alpha2-IFN) produced better-quality responses and
prolongation of survival in a pilot study, but this must be confirmed in a prospective study.
• Myeloma cells frequently become resistant to chemotherapy. One such mechanism is characterized by the
expression of glycoprotein P-170. Various agents such as verapamil or cyclosporine have been used to reverse
this resistance , but only modest success has been achieved.
• Growth factors such as granulocyte colony-stimulating factor (G-CSF) or granulocyte macrophage
colony-stimulating factor (GM-CSF) to shorten the duration of neutropenia (neutrophils fight infection) may
be helpful after high-dose chemotherapy.
Bone Marrow Transplantation This approach is an alternative for the therapy of multiple myeloma. There are two major approaches: allogeneic or autologous. There is no evidence that either is curative and most patients will suffer a relapse.
• With allogeneic transplantation, bone marrow is given from a matched donor following high-dose
chemotherapy and total body irradiation. The mortality is high (20-25 percent within the first three months)
and the patient often suffers from a peculiar form of rejection called graft- versus-host disease, in which the
transplanted marrow attacks the host tissue . This procedure is also possible only for people under 55, which
