Forty-five patients with multiple myeloma were given long-term low dose melphalan therapy over a seven-year period. Melphalan was administered orally on a daily schedule of 0.05 mg/kg/day initially and then reduced to 0.015 to 0.03 mg/kg/day to maintain the white blood cell count at 3,000 cells/cu mm. Thirteen patients had significant improvement in all objective indexes, 4 had improvement in one or more objective indexes, 9 had symptomatic improvement, and 19 did not improve. The median survival from the onset of treatment to death for the groups with objective signs of improvement was 33.5 months, 20.0 months for the symptomatically improved group, and 5.6 months for nonresponders. On the basis of our results, it is our opinion that long-term low dosage administration of melphalan is as effective in producing remissions and prolonging survival as the intermittent high dosage regimen.
Brook J, Bateman JR, Gocka EF, Nakamura E, Steinfeld JL. Long-Term Low Dose Melphalan Treatment of Multiple Myeloma. Arch Intern Med. 1973;131(4):545–548. doi:10.1001/archinte.1973.00320100073009
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