Improved survival duration with combination chemotherapy induction for multiple myeloma: a Southwest Oncology Group Study.

Abstract

Four hundred forty previously untreated patients with active multiple myeloma were entered into a randomized trial (Southwest Oncology Group [SWOG] study 7927/28) comparing vincristine, melphalan, Cytoxan (Mead Johnson & Company, Evansville, Ind), and prednisone (VMCP) alternating with vincristine, BCNU, Adriamycin (Adria Laboratories, Columbus, Ohio) and prednisone (VBAP) with or without levamisole with vincristine, Cytoxan, and prednisone (VCP) with or without levamisole for induction therapy. The treatment groups were well balanced for all of the known major prognostic factors. Patients receiving VMCP-VBAP responded (greater than or equal to 75% regression) more frequently to induction therapy, both without (54%) and with (44%) levamisole v VCP without (28%) or with (28%) levamisole (P less than .001). In addition, patients receiving VMCP-VBAP (+/- levamisole) had a survival duration determined to be significantly increased by all forms of analysis: 48 and 33 months for VMCP-VBAP without and with levamisole v 29 and 26 months for VCP without and with levamisole (P = .011 overall). Levamisole did not improve response rates or survival duration (P greater than or equal to .1), nor did it prolong remission in the maintenance phase (P = .85). Analysis of SWOG study 7704/05 (updated April 1985) confirmed improved survival for combination therapy v MP, but no benefit for levamisole. The overall findings support the use of VMCP-VBAP as an excellent treatment option for remission induction in patients with active myeloma of all stages and prognostic categories.

Current Issues in Cancer: Multiple myeloma

“…The South West Oncology Group ran a trial with a three way randomisation between melphalan-prednisone (120 patients) and vincristine-melphalan-cyclophosphamide-prednisone and vincristine- carmustine-doxorubicin-prednisone or vincristine-melphalan- cyclophosphamide-prednisone and vincristine-cyclophosphamide- doxorubicin-prednisone (224 patients) 24. Results with the two combination chemotherapeutic regimens were combined in the analysis and showed a significant advantage for patients who had been allocated these regimens.…”

Phase II evaluation of bisantrene in refractory multiple myeloma

“…All patients entered into this phase II trial had documented evidence of advanced, progressive multiple myeloma which had become resistant to treatment with standard anticancer drugs, including alkylating agents, vincristine and prednisone [7]. All patients had measurable disease, either on the basis of a monoclonal serum paraprotein spike observed on electrophoresis and/or Bence-Jones proteinuria quantitated by electrophoresis of the urine.…”

A phase II study of intravenous 6-thioguanine (NSC-752) in multiple myeloma

“…While multiple drug regimens appear to offer the best chance of disease control [1][2][3] new effective drugs are needed in the myeloma armamentarium. 6-Thioguanine (6-TG) is a member of the thiopural group of antimetabolites.…”