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Intensive treatment of myeloma Volume 2, issue 1, Janvier - Février 1996

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Service d'hématologie, CHU, Nantes.

In 1983, Tim Mc Elwain of the Royal Marsden Hospital reported on the efficacy of high dose intravenous melphalan (140 mg/m²) in patients with multiple myeloma even in high-risk disease. This opened the era of intensive clinical research in the field of high dose therapy for this incurable malignancy. Ten years later several conclusions are apparent : high dose therapy with autologous hemopoietic support is feasible in a great majority of patients ; such therapies are able to provide a significant prolongation of event free and overall survival in comparison with standard therapy and the tolerance and probably the efficacy are improved when applied early in the course of the disease. However, the ultimate goal (i.e. the cure of the disease) is far to be reached. To reach this goal some questions are to be answered : are successive courses of high dose therapy feasible and more efficient ? Is the purging of autologous graft from myelomatous clonogenic cells feasible, to which extent, is it useful ? How to control minimal residual disease ? The graft versus myeloma effect observed after allogeneic bone marrow transplantation needs more evaluation in order to explore immunotherapy. The improvement in the biology of myeloma cells already allows the investigation of the effect of various cytokines such as IL4. Only rigourous studies performed within groups of clinicians and scientists deeply involved in this disease will allow to answer these and other questions.