melphalan and Uremia

Topics: Antineoplastic Agents; Carmustine; Cyclophosphamide; Drug Therapy, Combination; Humans; Immunoglobulins; Lomustine; Melphalan; Multiple Myeloma; Neoplasm Staging; Plasmapheresis; Prednisone; Risk; Sodium Fluoride; Uremia

Results after an average follow-up of 3 years are presented on 485 patients in the 3rd MRC therapeutic trial in myelomatosis. The 353 non-azotaemic patients (199 now dead) were randomized between i.v. cyclophosphamide (CY) and oral melphalan with prednisone (M & P). THose treated with M & P fared slightly, but non-significantly, better. The 132 azotaemic patients (111 now dead) were randomized between i.v. CY and a 4-drug regimen, and both groups fared equally badly. Finally, after one year of the allocated treatment, 297 survivors (126 now dead) were randomized either to stop all treatment until evidence of relapse was obtained, or to continue treatment with azathioprine and vincristine, interrupted every 3 months for a course of the first-allocated treatment. The overall results suggested that maintenance therapy was beneficial, though the results were not statistically significant. Most of the difference was found among the few patients with unfavourable prognostic features who survived one year and were eligible for this randomization. In this, as in the two previous MRC trials, no striking differences have emerged between the therapeutic effects of different schedules of melphalan and/or CY. Consequently, a regimen of intermittent oral melphalan (with or without prednisone) seems satisfactory, because it is among the least toxic and most convenient. The 4th myeloma trial, now beginning, seeks to discover whether the addition of vincristine to the regimen can improve these results.

Topics: Aged; Clinical Trials as Topic; Cyclophosphamide; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Lomustine; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Prognosis; Uremia

The effect of certain disease parameters on remission and survial time was evaluated in 482 patients with multiple myeloma treated with intermittent courses of melphalan-prednisone combinations. Increasing degrees of anemia, hypercalcemia, azotemia, and high serum myeloma protein levels were associated with progressive lifespan shortening. The short survival of patients with anemia and hypercalcemia was associated with short remissions in responding patients with these abnormalities. The extent of tumor mass was defined from specific laboratory parameters reported by Durie to be associated with large numbers of plasma cells. More advanced stages of myeloma were associated with higher frequencies and degrees of normal immunoglobulin depression. The response rate was not affected by the tumor mass grade, but increasing tumor mass was associated with a shorter lifespan. Greater degrees of tumor reduction were associated with longer remission and survival times. Patients in whom a marked tumor reduction was rapid had shorter survival and remission times than patients who responded more slowly.

Topics: Aged; Anemia; Drug Therapy, Combination; Female; Humans; Hypercalcemia; Immunoglobulins; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Plasma Cells; Prednisone; Prognosis; Remission, Spontaneous; Serum Albumin; Time Factors; Uremia

A study was designed to evaluate the effectiveness of prednisone therapy in poor-risk patients with multiple myeloma. Patients were treated with melphalan alone or in combination with prednisone at doses of either 0.6 mg/kg or 0.3 mg/kg. The group of patients receiving melphalan and prednisone 0.6 mg/kg had significantly improved responses in hemoglobin, lowering of the M-protein concentration, and reduction of azotemia. Significant benefits attributable to prednisone were not demonstrated in the group receiving 0.3 mg/kg. Good responses have been shown to produce improved survival. The combination of melphalan and prednisone is effective in producing good responses, but the dose of steroids is important. A dose of prednisone of 0.6 mg/kg in gradually decreasing doses has been found to be effective in production of good responses, especially in the uremic patient.

Topics: Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Melphalan; Multiple Myeloma; Prednisone; Prognosis; Remission, Spontaneous; Risk; Uremia

Topics: Cyclophosphamide; Female; Humans; Male; Melphalan; Multiple Myeloma; Prognosis; Uremia

Topics: Animals; Bilirubin; Blood Platelets; Blood Urea Nitrogen; Bone Marrow Examination; Creatinine; Dogs; Graft Rejection; Infarction; Injections, Intravenous; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Transplantation; Leukocyte Count; Lymphocytes; Melphalan; Regional Blood Flow; Transplantation Immunology; Transplantation, Homologous; Uremia

Topics: Acute Kidney Injury; Aged; Bence Jones Protein; Blood Proteins; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Uremia

Topics: Adult; Aged; Amyloidosis; Anemia; Bence Jones Protein; Cyclophosphamide; Female; gamma-Globulins; Humans; Hypercalcemia; Immunochemistry; Immunoglobulin M; Male; Melphalan; Middle Aged; Multiple Myeloma; Uremia

Topics: Anemia; Bence Jones Protein; Female; Humans; Hypercalcemia; Male; Melphalan; Multiple Myeloma; Prognosis; Serum Globulins; Uremia; Urethane