[Use of interferon alpha in multiple myeloma]

Treatment of multiple myeloma

Conventional chemotherapies are no longer the only treatment in multiple myelomatosis. High-dose chemotherapy and autologous transplantation are not curative but do increase relapse-free survival time in young patients. Thalidomide is efficacious in refractory and relapsing myeloma and its evaluation is going on. Curative and preventive treatments of skeletal events, infections and anemia improve quality of life. All together, these strategies imply therapeutic knowledge and choices but allow an about 5-year-long median survival time in modern studies. Treatment options for myeloma now include, not only conventional chemotherapy regimens, but also novel symptomatic drugs and strategies that increase survival and/or quality of life, although they fail to provide a cure. In parallel with this expansion of the treatment armamentarium, physicians must acquire the knowledge needed to select the best treatment for the individual patient. After reviewing the rationale, effectiveness, and safety of each of these treatments, we will discuss the indications that we believe are legitimate.

[Standard treatment of multiple myeloma]

INTRODUCTION

About 50% of patients with multiple myeloma are older than 65 years and are not eligible for high-dose therapy, which has proved to be more efficacious than standard-dose chemotherapy in young patients.

CURRENT KNOWLEDGE AND KEY POINTS

Apart from high-dose therapy, no clear therapeutic advance has been achieved in the past 20 years, and melphalan-prednisone combinations remain reference treatments for many patients with multiple myeloma. Despite a great number of clinical trials, the use of interferon alpha is still controversial. The role of high-dose dexamethasone has been recently established and we are currently comparing dexamethasone alone, melphalan-dexamethasone and dexamethasone-interferon alpha treatments in a multicenter randomized trial (IFM 95-01). Bisphosphonates have also emerged as an efficacious and well tolerated adjuvant treatment. Optimal use of recently released bisphosphonates at various stages of the disease will possibly lead to a clear therapeutic advantage.

FUTURE PROSPECTS AND PROJECTS

Other drugs, such as erythropoietin or interferon gamma require further evaluation. The recent implication of metalloproteinases in multiple myeloma and the efficacy of metalloproteinase inhibitors in animal models and phase I/II clinical studies in solid tumors provide a strong rationale for the clinical evaluation of these agents in multiple myeloma.