About one-third of all patients treated initially with chemotherapy will not achieve a stable plateau response. And almost all patients with multiple myeloma who do respond to chemotherapy will eventually relapse if they do not die of some other disease in the meantime.
The decision about further treatment after a relapse has to take a number of factors into account, including prior treatment, where the recurrence occurs and personal considerations.
• If the relapse occurs after the initial therapy has been stopped, therapy with the same melphalan-prednisone
or multiple alkylating agent treatments is beneficial in a majority of patients.
• If the relapse occurs while the patient is receiving melphalan and prednisone , treatment should be changed to
weekly doses of cyclophosphamide and alternate-day prednisone, or a combination called VBAP (vincristine
+ BCNU + doxorubicin + prednisone). This change of treatment will be of some benefit for 30 to 40 percent
of patients.
• If a patient has already received these agents or does not respond to VBAP, a combination of vincristine +
doxorubicin + dexamethasone (VAD) can be given.
• If a patient is resistant to all of these agents or if the blood counts are low, a trial of high-dose prednisone or
