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EVOLVING STRATEGIES FOR THE TREATMENT OF MYELOMATOSIS

Advances in the treatment of myelomatosis since the introduction of melphalan have been slow, and relatively few agents with clinically useful activity have materialized. Nevertheless, the overall management of patients with the disease has improved appreciably, and there are now more therapeutic options, some of which offer the prospect of prolonging survival if not of cure. In order to put newer developments and future possibilities into perspective, it is necessary to retrace the ‘learning curve’ of the last three decades. As in other lymphoproliferative diseases, systems of staging, prognostic factors and definitions of response emerged as means of characterizing patient groups at presentation and following treatment. Differences with respect to these criteria need to be taken into account in making comparisons between the results of treatment in various studies. In drawing conclusions, the meta-analysis of data on a large number of patients from many trials-as being undertaken by the Clinical Trial Service Unit in Oxford (discussed at the first main meeting of the Myeloma Trialists’ Collaborative Group, Hertford College, Oxford, March 1994) -will be important. There is, however, an accumulated wealth of information and useful pointers on which to develop rational treatment strategies and the appropriate clinical trials.