Melphalan And Prednisone

The use of melphalan and prednisone (MP) to treat AL amyloidosis followed their establishment as effective therapy for multiple myeloma. A three-arm trial randomized 219 patients to colchicine alone, oral melphalan (0.15 mg/kg per day for 7 days) and prednisone (0.8 mg/kg per day for 7 days) every 6 weeks, or a combination of melphalan, prednisone, and colchicine (MPC).41 The median survival for patients receiving MP was 17 months, compared to 8.5 months for colchicine alone. Another trial comparing MPC to MP found improved survival with MP-based therapy.42 These studies have helped establish MP as one of the standard approaches to treat AL. However, most patients do not respond to this therapy, with objective responses seen in only 15-20% of patients. Most of these responses are limited to the patients with renal-only disease with preserved renal function. The median time to response is long (12 months), which necessitates prolonged therapy. This, however, has other consequences, such as the development of myelodysplasia or acute leukemia (actuarial risk of 21% at 3.5 years).43 In spite of these limitations, MP is used frequently in the therapy of AL, particularly in older patients, as it is relatively well tolerated.

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