The median survival of conventionally treated patients with multiple myeloma is 3 years. Modifications of conventional chemotherapy and the administration of interferon-α have failed to show an improved survival in most randomized trials. Therapy with dose-escalated alkylating agents (i. e. melphalan 140 mg/m2) induced higher remission rates than conventional treatment. If followed by allogeneic or autologous hematopoietic progenitor cell transplantation, the hematotoxicity of the described dose-escalated treatment could be reduced. Results of transplantation trials are summarized and discussed. The transplantation of autologous peripheral blood progenitor cells results in a faster hematopoietic reconstitution and a decreased high-dose therapy-related morbidity compared to autologous bone marrow and should therefore be preferred. Although the randomized French myeloma trial showed a significant survival advantage for patients following autologous transplantation, further randomized prospective studies are required to evaluate the role of blood progenitor cell transplantation after high-dose treatment in multiple myeloma. Prognostical factors and future treatment modalities for myeloma are discussed.

Keywords:
Multiple myeloma, High-dose treatment, Hematopoietic progenitor cell transplantation
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© 1995 S. Karger AG, Basel
1995
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