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In a population-based study, the Nordic Myeloma Study Group found a survival advantage for high-dose melphalan with autologous blood stem-cell support compared to conventional chemotherapy in myeloma patients under 60 yr of age (risk ratio: 1.62; confidence interval [CI] 1.22-2.15; p = 0.001). A study of health-related quality of life (HRQoL) was integrated in the trial, using the EORTC QLQ-C30 questionnaire. Of the 274 patients receiving intensive therapy 221 (81%) were compared to 113 (94%) of 120 patients receiving conventional melphalan-prednisone treatment. Prior to treatment, there were no statistically significant differences in any HRQoL score between the two groups. One month after the start of induction chemotherapy, the patients on intensive treatment had more sleep disturbance than the control patients. At 6 mo, corresponding to a mean of 52 d after high-dose melphalan, the patients on intensive treatment had moderately lower scores for global QoL and role and social functioning and there was also a significantly higher score for appetite loss. At 12 and 24 mo, the HRQoL was similar to that of the control patients. At 36 mo, there was a trend toward less fatigue, pain, nausea, and appetite loss in the intensive-treatment group. Thus, the 18 mo of prolonged survival seem to be associated with a good health-related quality of life. Despite the moderate HRQoL reduction associated with the early intensive chemotherapy phase, this treatment modality must be regarded as an important step forward in the care of multiple myeloma.

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With a bioassay sensitive for recombinant tumour necrosis factor at a concentration of 10(-4) ng/ml, we were able to detect tumour necrosis factor-like cytotoxicity in serum from three patients in the initial phase of septicaemia. The cytotoxic activity corresponded to a concentration of recombinant tumour necrosis factor of 2 X 10(-2)-3 X 10(-3) ng/ml serum. The concentration in cerebrospinal fluid was estimated to be three times higher than in serum. In 23 untreated patients with malignant disease of varying origin and stage, including two patients with severe cachexia, we were not able to detect tumour necrosis factor-like cytotoxicity.

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