Systemic irradiation in multiple myeloma: a report on nineteen cases.

Nineteen patients with relapsed or resistant multiple myeloma were treated with sequential half-body irradiation (12) and half-body irradiation only (seven). This treatment proved acceptable to the majority of patients and required one night's stay in hospital. Gastro-intestinal toxicity was transient and self limiting. Haematological toxicity was acceptable and recovery was complete in all but two of the 19 patients following half-body irradiation. However, only six of the 12 patients who subsequently had the remaining half irradiated completely recovered. Blood transfusions were required to correct anaemia in six patients, a platelet transfusion was given to one and a further patient required both platelet and blood transfusions. We observed no serious haematological complications. Six of the 13 patients who received upper half-body irradiation of probable chest infection, while one patient of the six who received lower half-body irradiation died of this complication. Some of the seven deaths may have been due to radiation pneumonitis. Two patients developed brain secondaries, which is a very rare occurrence in this disease. This may indicate a change in the natural history of myeloma produced by this new treatment. Subjective improvement was observed in 17 patients and relief of pain usually occurred within the first 24 h. Objective responses were noted in six patients. The median survival for all patients was 6 months with five patients alive 11-28 months at the time of this report. This treatment compares favourably to second line chemotherapy. It is perhaps more economical and better tolerated by patients. Further assessment in a larger number of patients with either untreated or relapsed disease is warranted.