Clinical Characteristics and Therapeutic Results in Multiple Myeloma

Lee, Eun Jung; Lee, Kyung Hee; Hyun, Myung Soo

Abstract

BACKGROUND: Although multiple myeloma is known to be a hematologic malignancy which cannot be cured, MP (melphaln, prednisone) based combination chemotherapy can prolong survival and improve quality of life for myeloma patients. The purpose of this report is to analyse chemotherapeutic effect and prognostic factors in myeloma patients.
METHODS
Between March, 1983 and March, 1995 at Yeungnam University Hospital 45 patients were diagnosed as multiple myeloma by SWOG criteria. Thirty-four of 45 patients were treated with MP chemotherapy.
RESULTS
1) The peak incidence was in 6th decade (20%) and male to female ratio was 2.2:1. The most common presenting symptom at first diagnosis was bone pain (55%). 2) Seventy one percent of the patients were clinical stage III. Performance status (ECOG scale) was grade 3 in 64%, grade 2 in 12%, grade 1 in 9% of the patients. 3) Hematologic findings showed anemia (Hb<8.5g/dL) in 40%, leukopenia in 27%, thrombocytopenia in 27% and increased ESR in 72% of the patients. Hypercalcemia was noted in 11% and renal failure in 29%. Serum immune electrophoresis revealed myeloma protein as IgG in 67%, light chain only in 24%, IgA in 9%, and kappa to lambda ratio was 1:2.6. 4) The median survival of chemotherapy group was 84 weeks and that of non-treatment group was 7 weeks. Response rate to MP chemotherapy was 35%, median response duration was 78 weeks. There was statistically significant survival difference between responder and non-responder (187 weeks to 27 weeks) (P<0.001). 5) Patients with ECOG grade>3, hypercalcemia, renal insufficiency, beta-2 microglobulin >4microgram/mL, non-treatment group, non-responder had lower survival time.
CONCLUSION
These results suggest that there is no prospect of cure with MP-based chemotherapy, but the survival benefit is meaningful for patients with chemotherapy responder. More intensive treatment, especially myeloablative treatment with bone marrow or peripheral blood stem cell transplantation should be investigated, considering curability.