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Is High-Dose Chemotherapy and Autologous Stem Cell Transplantation the Standard Treatment for Multiple Myeloma? For many years, the Alexanian regimen with melphalan and prednisone (MP) has been considered the standard treatment for advanced myeloma. The response was about 40%, the median duration of response 2 years, that of survival 3 years [1]. During recent years, combination regimens containing several alkylating agents, anthracyclines, and vinca alkaloids have been evaluated. Many of these regimens have been compared to MP in randomized studies [2, 3], but no significant difference in survival was apparent between the two treatments. However, since 1996 the standard treatment for untreated patients (and those with limited pretreatment) below 60 years of age with a good performance status is induction combination chemotherapy followed by high-dose chemotherapy with autologous stem cell support. The Intergroupe Français du Myélome (IFM 90 trial) has recently compared conventional chemotherapy with high-dose therapy supported by autologous bone marrow tansplantation (ABMT) [4]. 200 patients were randomized to receive either conventional chemotherapy (18 alternating cycles of polychemotherapy VMCP/VBAP) or high-dose therapy following 4–6 cycles of VMCP/VBAP. This consisted of high-dose melphalan at 140 mg/m2 and total body irradiation (8 Gy in 4 fractions) followed by ABMT. In this study, the high-dose treatment was superior to conventional therapy in terms of overall (81 vs. 57%) and complete (22 vs. 5%) response rates. The event-free (EFS) 28 vs. 10%) and overall survival (OS) (52 vs. 12%) at 5 years also were significantly superior in the high-dose arm [5]. In a matched-pair comparison again the high-dose treatment was demonstrated to provide a superior EFS and OS when compared to conventional therapy [4]. ...

High-Dose Chemotherapy with Hematopoietic Stem Cell Transplantation for Patients with Advanced Multiple Myeloma