Q J Med 1999; 92: 11-14
© 1999 Association of Physicians
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Treatment of myeloma
From the Department of Haematology, Royal London Hospital, London, UK
Introduction
Myeloma is a malignant disease characterized by the clonal proliferation of plasma cells within the bone marrow. It has an annual incidence of 2–4 per 100 000 population, with 2000–3000 new cases per year in the UK, and accounts for 1% of all malignancies. The majority are over 55, with a median age at diagnosis of 70. Myeloma can manifest itself in a variety of ways—bone marrow failure, susceptibility to infection, hypercalcaemia, bony destruction resulting in pain or pathological fracture, renal failure and amyloidosis. It is an incurable illness, with a median survival for all patients of 3 years. Less than 3% survive more than 10 years and the clinical history is usually one of multiple relapses.
Chemotherapy
Since myeloma is usually a disseminated disease at presentation, chemotherapy is the main treatment modality. Some asymptomatic patients with low tumour mass1 need no treatment; however, those patients with extensive bone disease, bone
Single-agent chemotherapy
Combination chemotherapy
Myelo-ablative therapies
Autologous/peripheral blood stem cell transplantation
Allogeneic bone-marrow transplantation
Interferon-alpha
Relapsed and refractory disease
Supportive measures
Summary
Notes
References
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