ABSTRACT
Although numerous studies have documented tumour responsiveness to both chemotherapy and radio-therapy, multiple myeloma remains an incurable disease. The standard treatment for myeloma for more than three decades has remained a combination of oral melphalan and prednisolone [1]). Various other combinations such as ABCM, VMCP/VBAP and MOCCA [2-5] have been used, but with the exception of ABCM no other treatment strategy has shown a benefit over melphalan and prednisolone. A recent meta-analysis of combination chemotherapy versus melphalan and prednisolone by Gregory et al. [6] of 3814 patients concluded that both treatments were equally effective. A subgroup analysis in this same study revealed melphalan and prednisolone to be superior for patients with intrinsically good prognosis disease, while combination chemotherapy was beneficial for poor prognosis myeloma. This meta-analysis, however, excluded the important MRC V trial [7] which documented the benefits of ABCM combination chemotherapy over oral melphalan, because the control arm was treated with melphalan alone.
