![]() ![]() Several combinations have built over the MP backbone. Therapy with melphalan plus prednisone (MP) was the standard of care for patients with newly diagnosed MM for almost 40 years and when alternative combinations were developed as induction therapy for individuals eligible for high-dose melphalan therapy with hematopoietic stem-cell transplantation, it remained the standard of care for elderly or unfit patients. Current Use of “Old” Alkylating Agents 2.1. The regimen is toxic, but VTD-PACE and similar regimens are still being used occasionally for refractory patients at some centers. ![]() ![]() One of the more noteworthy attempts was the VTD-PACE (bortezomib, thalidomide, dexamethasone, cisplatin, doxorubicin, cyclophosphamide and etoposide) regimen for induction and consolidation before transplant, in the total therapy 3 study, showing near-complete remission and 2-year survival rates in more than 80% of the patients. Over the years, several other alkylating drugs and other chemotherapeutics have been tested and used, including cyclophosphamide, carmustine, lomustine, bendamustine, cisplatin, vincristine and doxorubicin, also in the context of allogeneic stem cell transplantation. After the first positive report in 1983, several studies accumulated on the benefit of what became known as high-dose-melphalan with autologous stem cell transplant (HDM-ASCT), and, after a large, randomized study published in 1996, it became established as the standard-of-care for young newly diagnosed myeloma patients. The next big leap in myeloma treatment was to use high doses of melphalan, in the context of autologous stem cell transplant. ![]()
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