Clinical evaluation of response or escape to chemotherapy and of survival of patients with multiple myeloma. A prospective study of 202 patients (1975-1982).

Between 1975 and 1982, 202 previously untreated patients with multiple myeloma (MM) and clinical evidence of disease progression received intensive chemotherapy every 3-5 weeks to induce remission. Treatment regimen included intermittent courses of a combination of cycle non-specific drugs (melphalan, cyclophosphamide) plus vincristine and prednisone, with or without adriamycin. Several other drugs having some efficacy in MM were used in case of primary treatment failure or in relapse. The overall median survival was 29 months, with an eight-year actuarial death-rate (related to MM) equal to 75%. Forty percent of patients had disease progression and short survival (median = 9 months, early deaths included). Fifty percent had stable or regressive disease (greater than or equal to 50 less than 99% cell mass regression) and a dramatic improvement of survival (4 years survival rate = 50% vs 0% for refractory MM p less than 10(-9]. Ten percent achieved the best remission (i.e. disappearance of the monoclonal protein, defined as greater than 99% regression and 100% of greater than or equal to 1 year plateau) with the longest survival (4 years survival rate = 80% p less than 0.02). In patients achieving a greater than or equal to 75% regression and a 1 year plateau, the remission duration was not shortened in off-treatment patients. Three types of relapse were observed: "smoldering" (13%), "slow" (49%) and "fulminant" (38%); with a major influence on survival.