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Blood, Vol. 94 No. 4 (August 15), 1999:
pp. 1248-1253
Dose-Intensive Melphalan With Stem Cell Support (MEL100) Is
Superior to Standard Treatment in Elderly Myeloma Patients
Antonio Palumbo,
Sabrina Triolo,
Chiara Argentino,
Sara Bringhen,
Alida Dominietto,
Cecilia Rus,
Paola Omedè,
Corrado Tarella,
Alessandro Pileri, and
Mario Boccadoro
From the Divisione di Ematologia dell'Università di Torino,
Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.
A clinical relationship between dose-intensity of melphalan and
response rate has been demonstrated in multiple myeloma. Promising results have been reported after 200 mg/m2 melphalan,
especially in younger patients. It is uncertain whether 100 mg/m2 melphalan (MEL100) can offer similar results in older
patients. To address this issue, patients were treated with 2 or 3 MEL100 courses followed by stem cell support. Seventy-one patients
(median age, 64 years) entered the protocol at diagnosis. Their
clinical outcome was compared with that of 71 pair mates (median age,
64 years) selected from patients treated at diagnosis with oral
melphalan and prednisone (MP) and matched for age and
 2-microglobulin. Complete remission was 47% after MEL100 and 5%
after MP. Median event-free survival was 34 months in the MEL100 group
and 17.7 months in the MP group (P < .001). Median overall
survival was 56+ months for MEL100 and 48 months for MP (P < .01). In a multivariate analysis, 2-microglobulin levels and
MEL100 were independent risk factors associated with outcome: superior
event-free and overall survival were observed in patients presenting
low 2-microglobulin levels at diagnosis and receiving MEL100 as
induction regimen. In conclusion, MEL100 was superior to MP in terms of
complete remission rate, event-free survival, and overall survival.
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