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. 2000 Mar 6;82(7):1254–1260. doi: 10.1054/bjoc.1999.1087

Long-term survival of stage I multiple myeloma given chemotherapy just after diagnosis or at progression of the disease: a multicentre randomized study

A Riccardi 1, O Mora 1, C Tinelli 2, D Valentini 1, S Brugnatelli 1, R Spanedda 3, A De Paoli 4, L Barbarano 5, M Di Stasi 6, M Giordano 7, C Delfini 8, G Nicoletti 9, C Bergonzi 10, E Rinaldi 11, L Piccinini 12, E Ascari 1; for the Co-operative Group of study and Treatment of Multiple Myeloma
PMCID: PMC2374495  PMID: 10755397

Abstract

We conducted a randomized trial to evaluate whether melphalan-prednisone (MPH-P) treatment administered just after diagnosis improves survival of stage I multiple myeloma (MM). Between January 1987 and March 1993, 145 consecutive previously untreated patients with stage I MM were randomized between treatment with MPH-P (administered for 4 days every 6 weeks) just after diagnosis and treatment only at disease progression. Survival was not influenced by MPH-P treatment either administered just after diagnosis or at disease progression (64 vs 71 months respectively). Comparing the first with the second group the odds ratio of death is 1.17 (95% confidence interval 0.57–2.42;P = 0.64). Disease progression occurred within a year in about 50% of patients who were initially untreated. Response rate was similar in both groups, but duration of response was shorter in patients who were treated at disease progression (48 vs 79 months, P = 0.044). Patients actually treated at disease progression (34/70) survived shorter than those who had neither disease progression nor treatment (56 vs > 92 months;P = 0.005). Starting MPH-P just after diagnosis does not improve survival and response rate in stage I MM, with respect to deferring therapy until disease progression. However, patients with stage I MM randomized to have treatment delayed and who actually progressed and were treated had shorter survival than those with stable disease and no treatment. Biologic or other disease features could identify these subgroups of patients. © 2000 Cancer Research Campaign

Keywords: multiple myeloma, stage I, early or delayed treatment, survival

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Footnotes

The following centres also participated in this study: Medicina I, Ospedale di Alessandria (Dr A Pagetto); Medicina I, Ospedale di Melegnano (Prof G Santagati); Medicina I, Ospedale di Gallarate (Dr A Ceriani); Cattedra di Ematologia, Università di Parma (Dr G Dotti); Medicina B, Ospedale di Biella (Dr M Badone); Medicina Generale, Ospedale di Somma Lombardo (Dr A Daverio); Medicina C, Ospedale di Varese (Dr N Brumana); Medicina A, Ospedale di Varese (Dr G Pinotti)

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