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The treatment of multiple myeloma--an important MRC trial.

British Journal of Cancer
Nature Publishing Group
Publication Date
  • Research Article
  • Biology
  • Medicine


Br. J. Cancer (1994), 70, 781-785 C) Macmillan Press Ltd., 1994 GUEST EDITORIAL The treatment of multiple myeloma-an important MRC trial P.W.M. Johnson & P.J. Selby ICRF Cancer Medicine Research Unit, St James's University Hospital, Leeds, UK. In spite of its reputation as a chemosensitive malignancy, multiple myeloma remains fatal for nearly all those who contract it. The mortality has changed little in the last 30 years (Feinleib & MacMahon, 1960), although the duration of the illness has been extended from a median of 7 months prior to the introduction of chemotherapy to around 2 years today (a figure which varies between I and 4 years depending upon the selection of patients) (Alexanian et al., 1969; Durie & Salmon, 1975; Case et al., 1977; Cooper et al., 1986). There are, however, some signs that the situation may be changing. Recent developments in treatment intensification, maintenance therapy and newer biological approaches all suggest that in the forseeable future prolonged remissions or even cures may be obtained, particularly in selected sub- groups of patients. To define these, a large number of studies examining prognostic factors have been carried out, with $-microglobulin levels (Cassuto et al., 1978; Bataille et al., 1984; Cuzick et al., 1985; Greipp et al., 1988; Dunie et al., 1990), interleukin 6/C-reactive protein levels (Bataille et al., 1989; Ludwig et al., 1991a), plasma cell labelling index (Durie & Bataille, 1989; Greipp et al., 1993), lactate dehyd- rogenase (Dimopoulos et al., 1991) and thymidine kinase activity (Brown et al., 1993) all being used to supplement clinical information on the severity of the disease. There remain several areas of controversy which require clarification, principally the relative merits of combination chemotherapy versus single alkylating agents with prednis- olone, the place of myeloablative therapy and the role of interferon. While there is no shortage of information on conventional and interferon therapy from randomised trials, much of i

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