Intermediate Dose Melphalan for de novo Multiple Myeloma gives high complete response rate and durable long term survival

Reviewer: Julie Draznin Maltzman, MD
Last Modified: December 7, 2002

Presenter: Mathew Streetly
Presenter's Affiliation: Queen Elizabeth Hospital, Woolwich, UK
Type of Session: Poster


  • Multiple Myeloma remains a disease with extremely high recurrence rates even after agressive chemotherapy.
  • Oral Melphalan has a median survival rate of 2-4 years in those pts who respond. Complete remission is achieved in <5% of the patients.
  • IV Melphalan can produce more predictable plasma levels than the oral formulation and can produce a higher rate of complete remission.
  • This abstract presents data of intermediate dose IV Melphalan as initial induction therapy with high response rates.

Materials and Methods

  • This was a multicenter, non-randomized, prospective study of consecutive previously untreated stage II or III Multiple Meyloma pts.
  • Pts recieved 25mg/m2 over 30 minutes of Melphalan with dexamethasone 40mg orally each day for four days. Treatment was repeated every 28 days.
  • Pts also received maintenance therapy if interferon of 1-3 MU 3X weekly.
  • Response rate was measured by serum and urine paraprotien levels and amount of bone marrow plasma cells.


  • Overall response rate was 66% (a reduction in >25% of paraprotien level) of which 33% were were complete responders.
  • 6 patients had stable disease on this therapy.
  • 15 patients proceeded to autologous bone marrow transplants
  • 21% of these patients continue to be alive at 109 months of follow up.
  • Treatment was well tolorated. Only 4 deaths occurred during the study. One was treatement related -- due to sepsis. 2 deaths were non treatment related -- vascular events. And one death was unexplained.

Author's Conclusions

  • Intermediate dose Melphalan is well tolerated and capable of producing complete remission responses equal to those published with high dose melphalan.
  • Most pts had enough of a stem cell reserve to allow for a subsequent autologous bone marrow transplant.

Clinical/Scientific Implications

    Intermediate dose IV Melphalan, as opposed to high dose, is an effective treatment for Multiple Myeloma with long term survival.

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