The Pharmaceutical Journal
Vol 270 No 7249 p675
17 May 2003

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High-dose chemotherapy confirmed as more effective in multiple myeloma

High-dose chemotherapy with stem cell rescue is more effective than standard dose chemotherapy in multiple myeloma, researchers say.

Professor J. Anthony Child, Cancer Research United Kingdom Clinical Centre and Leukaemia Research Fund Unit, University of Leeds, and colleagues conducted a study in 401 patients with multiple myeloma. Half were given a standard chemotherapy regimen of doxorubicin, carmustine, cyclophosphamide and melphalan.

The other half were given high-dose chemotherapy consisting of combination chemotherapy (with doxorubicin, vincristine, methylprednisolone and cyclophosphamide) after which stem cells were harvested. A high dose of melphalan was then administered. This was followed by re-infusion of stem cells 24 hours later.

Patients in the intensive therapy group had a higher overall rate of response and a higher rate of remission than patients in the standard therapy group. The median survival rate in the high-dose therapy group was 54.1 months, compared with 42.3 months in the standard therapy group.

Furthermore, the median duration of progression-free survival was 31.6 months in the intensive therapy group and 19.6 months in the standard therapy group.

The authors comment that an approach involving high-dose chemotherapy with stem-cell rescue often induces relatively high rates of tumour regression across a range of tumours, compared with standard therapy. They add that this has led to enthusiasm for its use, despite a lack of supporting trial evidence. “The most important finding in our trial was the increase in median survival of approximately one year among patients in the intensive therapy group, as compared with those in the standard-therapy group,” they conclude (New England Journal of Medicine 2003;348:1875).

Nish Saini, haematology pharmacist at University College London Hospitals NHS Trust, told The Journal that the study confirmed the belief that up-front consolidation with high-dose chemotherapy followed by stem cell rescue provides a significant advantage both in terms of progression-free and overall survival. “Certainly this reflects the practice within the North London Cancer Network and our current myeloma treatment guidelines more or less reflect this approach; the one difference would be that we would not pursue a high dose approach in patients whose disease progressed through induction and salvage treatment.”

However, he questioned why different induction regimens had been used in the two arms of the study and added that the regimen chosen for the standard treatment group is not one that would be considered a standard approach in many centres since other treatments are believed to produce higher remission rates.