Treatment of multiple myeloma: A randomized study of three different regimens

The results of an Italian multicentric trial for treatment of symptomatic Multiple Myeloma (MM) are reported. One hundred and thirty-three previously untreated patients were singled out at random for three different chemotherapy schedules: Melphalan plus Prednisone (M.P.) x 6 monthly cycles; Vincristine plus Melphalan plus Cyclophosphamide plus Prednisone (VMCP) x 6 monthly cycles; Peptichemio, Cyclophosphamide, BCNU. Drugs in this latter schedule were administered sequentially, for a period of six months. Criteria for response, progression and relapse were those of the Southwestern Oncology Group. Fifteen patients in MP chemotherapy (35%) and 20 patients in VCMP chemotherapy (46%) achieved an objective response (decrease of at least 50% in the synthesis index of Monoclonal Component (M.C.)), While only 3 out of the other 21 patients assigned to the third schedule responded to treatment. No significant differences were noted in the survival curves in either of the three treatment groups. The 38 responding patients did not receive maintenance therapy; no significant difference was found in remission duration between patients in MP and VCMP arms, with a median duration of 16 months for the whole group. No statistical difference was observed between survival and remission curves of patients with a 'response' (M. spike reduction > 75%) and those with 'improvement' (M. spike reduction between 75 and 50%). The authors conclude that the inclusion of Vincristine in a combination chemotherapy does not produce clear survival benefits; a longer induction period (12 cycles) could allow a better differentiation between MP and VMCP regimens

Treatment of multiple myeloma: A randomized study of three different regimens

The results of an Italian multicentric trial for treatment of symptomatic Multiple Myeloma (MM) are reported. One hundred and thirty-three previously untreated patients were singled out at random for three different chemotherapy schedules: Melphalan plus Prednisone (M.P.) x 6 monthly cycles; Vincristine plus Melphalan plus Cyclophosphamide plus Prednisone (VMCP) x 6 monthly cycles; Peptichemio, Cyclophosphamide, BCNU. Drugs in this latter schedule were administered sequentially, for a period of six months. Criteria for response, progression and relapse were those of the Southwestern Oncology Group. Fifteen patients in MP chemotherapy (35%) and 20 patients in VCMP chemotherapy (46%) achieved an objective response (decrease of at least 50% in the synthesis index of Monoclonal Component (M.C.)), While only 3 out of the other 21 patients assigned to the third schedule responded to treatment. No significant differences were noted in the survival curves in either of the three treatment groups. The 38 responding patients did not receive maintenance therapy; no significant difference was found in remission duration between patients in MP and VCMP arms, with a median duration of 16 months for the whole group. No statistical difference was observed between survival and remission curves of patients with a 'response' (M. spike reduction > 75%) and those with 'improvement' (M. spike reduction between 75 and 50%). The authors conclude that the inclusion of Vincristine in a combination chemotherapy does not produce clear survival benefits; a longer induction period (12 cycles) could allow a better differentiation between MP and VMCP regimens

Intermediate-dose (25 mg/m2) intravenous melphalan for patients with multiple myeloma in relapse or refractory to standard treatment

Intermediate-dose (25 mg/m2) intravenous melphalan has been evaluated in 34 multiple myeloma patients refractory to standard chemotherapies. The median time from diagnosis to entering of patients into the study was 27 months (range 7-71 months). A response was obtained in 12/34 patients (35%). 4 of 12 responding patients have relapsed and 2 of these have died; 8 responders have not relapsed and are still alive. The median duration of survival after 28 months of follow-up has not yet been reached in the group of patients responding to treatment. However, the overall median duration of survival for the 34 patients entered into the study was 8 months. The median duration of response was 16 months. Toxicity was limited to leukopenia, thrombocytopenia, nausea and vomiting. This lack of severe toxicity allowed us to administer the drug on an outpatient basis. The response rate and the low toxicity observed in this group of patients are encouraging and suggest that intermediate-dose intravenous melphalan is an effective and safe second line treatment for patients with multiple myeloma not responding to conventional treatmen

Non-Hodgkin lymphomas of the central nervous system

Non-Hodgkin lymphomas (NHL) of the Central Nervous System (CNS) are rare but they nonetheless constitute a clinical, biological and therapeutic problem of great interest. Primary lymphomas of the CNS account for 2% of all malignant lymphomas and for 0.3-1.5% of all intracranial tumors. Surgery and radiotherapy afford only poor control of the disease. The most satisfactory results have been achieved with combination therapy, surgery + radiotherapy + chemotherapy, but the optimal combination has still to be devised. Secondary neuromeningeal involvement affects a fair number of patients with systemic NHL. The symptoms are broadly the same as in CNS NHL and the treatment as problematic. There have recently been suggestions that the onset of CNS NHL may be exacerbated by immunodeficiency states such as occur in patients who have undergone organ transplantation, in autoimmune disease and, still more recently, in the acquired immunodeficiency syndrome (AIDS). The frequency of these tumors is anyway on the increase and a better insight into the disease in essential.

Ceftriaxone plus amikacin in a single daily dose as empiric antibiotic therapy in granulocytopenic patients

In our study ceftriaxone plus amikacin were employed as empirical antibiotic therapy. This antibiotic treatment allows for a once daily administration and has a broad spectrum of activity. 21 febrile episodes were treated with an antibiotic regimen of ceftriaxone 50 mg/kg/day and amikacin 30-35 mg/kg/day i.v. An earlier pilot study was carried out in which 47 febrile episodes were treated with an antibiotic regimen of ceftriaxone 80-100 mg/kg/day i.v. and amikacin 30-35 mg/kg/day i.v. in a single dose. The overall response rate was 76% (16/21) and 79% (37/47) for the pilot study. During the treatment no side effects were observed and aminoglycoside related toxicity did not occur. In conclusion, this empiric antibiotic therapy gives a high response rate and allows for a single daily administratio

Non-Hodgkin lymphomas of the central nervous system

Non-Hodgkin lymphomas (NHL) of the Central Nervous System (CNS) are rare but they nonetheless constitute a clinical, biological and therapeutic problem of great interest. Primary lymphomas of the CNS account for 2% of all malignant lymphomas and for 0.3-1.5% of all intracranial tumors. Surgery and radiotherapy afford only poor control of the disease. The most satisfactory results have been achieved with combination therapy, surgery + radiotherapy + chemotherapy, but the optimal combination has still to be devised. Secondary neuromeningeal involvement affects a fair number of patients with systemic NHL. The symptoms are broadly the same as in CNS NHL and the treatment as problematic. There have recently been suggestions that the onset of CNS NHL may be exacerbated by immunodeficiency states such as occur in patients who have undergone organ transplantation, in autoimmune disease and, still more recently, in the acquired immunodeficiency syndrome (AIDS). The frequency of these tumors is anyway on the increase and a better insight into the disease in essential.