The CancerWeb Report, What's New In Cancer: June, 1996
Multiple Myeloma

• Treatment with melphalan - Multiple myeloma is a disease originating in the bone marrow, but which is notable for the damage it causes in the bone, with frequent painful fractures, and characterized by a protein - Bence-Jones protein - in the urine. In about one-fifth of patients the kidney function is deficient. The disease is treatable with the drug at a dose so high (200 mg/m2) that it completely depletes the bone marrow of blood-forming (stem) cells, necessitating that stem cells be collected from the blood before treatment, and returned afterwards to support recovery of blood-forming capacity. Patients with kidney problems are not usually given this high dose, out of fear that they cannot tolerate it. Researchers from the Universities of Arkansas and Arizona, found very marked individual variations by factors of five- or ten-fold in the way patients handled the drug. However, deficiencies in kidney function did not affect the way melphalan is metabolized and cleared from the body, the quality of the stem cell collections, or the recovery of blood-forming ability. They suggested that there is need to tailor the dose to take individual metabolic differences (but not kidney function) into account to get the best antitumor effect. (Tricot, Clin Cancer Res 2:947, 1996)