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April 21, 1969

Cyclophosphamide vs Melphalan in Myeloma

Author Affiliations

Boston City Hospital

JAMA. 1969;208(3):536. doi:10.1001/jama.1969.03160030110026

To the Editor:—  Drs. Rivers and Patno (207:1328, 1969) have clearly demonstrated that cyclophosphamide and melphalan are equally effective chemotherapeutic agents in plasma cell myeloma. I am impressed, however, by the striking difference between the median survival of the placebo group from an earlier study (15 weeks) and that of the "no response" group of the present series (48 weeks). Is it possible to attribute this threefold increase in longevity to the use of drugs despite any objective or subjective response data?It has become increasingly apparent that survival in many hematopoietic malignancies including Hodgkin's disease and plasma cell myeloma is a function not only of chemotherapy or radiotherapy but also relates to the number of objective and subjective prognostic factors present during initial evaluation.1 An intriguing possibility is that with increased diagnostic acumen, including immunoelectrophoresis, myeloma patients are being uncovered at an earlier stage of their disease. In