Combination Chemotherapy With Intermittent l-3-Bis(2-Chloroethyl)l-Nitrosourea (BCNU), Cyclophosphamide, and Prednisone for Multiple Myeloma

In order to study the effectiveness of the drug combination BCNU, cyclophosphamide, and prednisone (BCP) in myeloma, the Southeastern Cancer Study Group entered 126 previously untreated and 33 previously treated patients in this study. Patients received cyclophosphamide, 400 mg/sq m, BCNU, 75 mg/sq m, and prednisone, 80 mg/sq m, for 7 days, every 4 wk, and were evaluated for response after 6 mo of therapy. Responding patients were continued on therapy and followed for evaluation of survival. Previously untreated patients were evaluated for good and poor risk status as well as clinical stage by calculation of tumor cell mass. These calculated values, as well as the individual components such as blood urea nitrogen (BUN), immunoglobulin (Ig) type, and hemoglobin (Hb), were evaluated for correlation with response and survival. The response rate was approximately 50% for all untreated patients regardless of cell mass or risk status. Toxicity was not excessive, and no case of acute leukemia was seen. Median survival for untreated patients was 27.8 mo; good risk patients, 44 mo; and poor risk, 12 mo. Though cell mass status did not correlate well with survival, individual factors of BUN, IgAλ, and IgGκprotein types had strong predictive value. Using these factors, a model for survival predication was created that had high predictive value in this group of patients. The study indicates that this treatment regimen is effective and could be used as an alternative to standard chemotherapy or in sequential combinations. Since it does not contain melphalan, it might be attractive if melphalan-contain-ing regimens prove to be particularly leuke-mogenic. The survival-predictive model may be useful in assessment of patient prognosis and will be further evaluated in subsequent group studies.