Over the past seven years there has been progress in 
treating relapsing or refractory disease. Both high-dose 
dexamethasone alone, and high dose dexamethasone in 
combination with 4 day continuous infusions of vincristine 
and adriamycin (VAD) have been shown to produce clinical 
improvement and a decrease in paraprotein level in 40-75% of 
these patients. 30,31 
INTERFERON THERAPY: Alpha interferon has been studied in 
several clinical situations in myeloma. It's utility in 
induction regimens is not yet clear, but active studies are 
ongoing. 32 ' 34 Mandelli and coworkers have reported that 
administration of alpha-interferon to patients who had 
already responded to standard induction chemotherapy 
prolonged response duration and survival. 23 Relapse 
occurred in 25 of 50 patients in the group given interferon 
maintenance therapy, and in 41 of 51 control patients. . 
Median duration of response was 26 months in the interferon 
group and 14 months in the control group, and median 
survival was also longer in the interferon-treated group (52 
months versus 39 months) . The mechanism of interferon 
activity in myeloma is unknown, but this agent seems to be 
uniquely active in controlling low tumor-burden "plateau 
phase" disease, possibly due to immune modulation or 
inhibition of cell cycle entry by quiescent myeloma "stem 
cells". 35,36 
ALLOGENEIC BONE MARROW TRANSPLANTATION: Over the past 5 
years interest in using marrow-ablative regimens in multiple 
myeloma has become more intense due to early encouraging 
results with both allogeneic and autologous bone marrow 
transplantation. The high risk of fatal graft-versus-host 
disease in older patients and lack of donors has precluded 
allogeneic bone marrow transplantation in all but a small 
subset, and no large series of patients have been 
transplanted with a standardized regimen. However, several 
centers have transplanted, small numbers of highly selected 
patients,, and reported that - up to 5Q% had sustained complete 
responses t (i.e. no detectable paraprotein) or stable minimal 
disease post aiiogeneic transplant. 37 ' 39 A total of 90 
patients transplanted with, various conditioning regimens 
from fully matched sibling donors at a number of European 
centers were recently analyzed. 3 The median age of 
transplanted patients was 42. 38% died of transplant-related 
causes, 43% achieved a complete remission, and the actuarial 
survival at 76 months was 40%. There was a higher relapse 
rate in a small series of patients receiving syngeneic 
transplants, suggesting that graft-versus-myeloma effects 
might be important. 40 
AUTOLOGOUS TRANSPLANTATION: Because so few patients with 
multiple myeloma are eligible for allogeneic bone marrow 
[40] 
Recombinant DNA Research, Volume 16 
