Multiple myeloma involves all of the red bone marrow and is widespread when the diagnosis is made. Consequently, there is no adjuvant or neoadjuvant treatment. All therapy is for metastatic disease.
Not all patients who meet the minimal criteria for diagnosis of multiple myeloma should be treated. Because the disease is not curable and therapy causes potential side effects and involves cost, treatment should be delayed until there is evidence of progression , symptoms appear or treatment is needed to prevent complications.
Chemotherapy The major controversy in chemotherapy is whether treatment should be with a
single alkylating agent such as melphalan together with prednisone or a combination of alkylating agents .
Melphalan and prednisone are given daily by mouth for four to seven days every four to six weeks. Since food interferes with the absorption of melphalan, it is important to take this drug on an empty stomach, either one hour before breakfast or three hours after supper. Prednisone is taken as a single dose with breakfast. These drugs induce an objective response in 50 to 60 percent of patients. The dosage of melphalan may be changed, depending on the response of the white blood cell and platelet counts. The dose of melphalan should be increased to the point that some fall in the white blood cell or platelet count occurs three weeks after starting a course of treatment.
