The Hematology DSG noted that the use of transplantation for patients with myeloma varied among practice s across the province .
In terms of survival , is  peripheral blood stem-cell  or  marrow transplantation better than conventional chemotherapy ?
What is the relative efficacy of autologous versus allogeneic transplantation ?
What specifics of the transplantation process can be recommended ?
The addition of interferon is unlikely to influence outcomes in the control group .
In Terms of Survival , Is Autologous Peripheral Blood Stem-Cell or Bone Marrow Transplantation Better than Conventional Chemotherapy ?
After more than three decades of clinical trials testing various st and ard-dose chemotherapy regimens , the disease course of patients with multiple myeloma has not changed appreciably .
Conventional chemotherapy can provide effective palliation but is not curative ( 1 ) .
Case series have described encouraging results in patients with myeloma undergoing allogeneic or autologous bone marrow or peripheral blood stem-cell transplantation ( 2 ) .
Other studies of transplantation , including r and omized trials , have been reported in the past 6 years ( 3 , 4 ) .
To facilitate decisions about treatment options , practice guidelines have been developed for use by health care providers and consumers .
In Ontario , Canada , cancer treatments and policies are led by a state-funded organization , Cancer Care Ontario .
To help derive treatment options , Cancer Care Ontario has developed the Program in Evidence -Based Care , which includes the Practice Guidelines Initiative .
To approach this topic , the DSG addressed the following questions : What is optimal st and ard-dose chemotherapy for patients with myeloma ?
When should transplantation be performed ?
Who should ( or should not ) receive a transplant ?
A randomized trial of maintenance interferon following high‐dose chemotherapy in multiple myeloma: long‐term follow‐up results
High‐dose chemotherapy ( melphalan ) with autologous marrow stem cell support ( AMSCS ) results in high response rates in multiple myeloma ( MM ) , with up to 50 % of patients achieving complete remission . However , these remissions are generally not durable . As the cytokine interferon alpha has been shown to prolong partial response following conventional chemotherapy , this trial was conducted to evaluate its role following high‐dose chemotherapy . 85 patients were r and omly assigned to maintenance treatment with interferon alpha , 3 × 106 units/m2 subcutaneously three times weekly until relapse or no further treatment following recovery from high‐dose chemotherapy ( melphalan 140–200 mg/m2 or busulphan 16 mg/kg ) combined with AMSCS . At 5.8 years following the accrual of the last patient in this trial , 38 patients had died  , 17 in the interferon arm and 21 in the control arm . The median progression‐free survival ( PFS ) in the 42 patients r and omized to interferon alpha was 46 months versus 27 months in the controls . Both overall survival and PFS , which were highly significant at median follow‐up of 52 months , have now ceased to be significant , because most patients have ultimately succumbed to their disease . Interferon  was tolerated by the majority of patients with very good compliance . Toxicity consisted mainly of flu‐like symptoms and malaise which were usually self‐limiting . The results of such a pilot study should be carefully interpreted and the benefits of interferon should be confirmed in larger multi‐centre studies in the setting of minimal residual disease following autologous transplantation
The Hematology DSG noted that the use of transplantation for patients with myeloma varied among practice s across the province .
In terms of survival , is  peripheral blood stem-cell  or  marrow transplantation better than conventional chemotherapy ?
What is the relative efficacy of autologous versus allogeneic transplantation ?
What specifics of the transplantation process can be recommended ?
The addition of interferon is unlikely to influence outcomes in the control group .
In Terms of Survival , Is Autologous Peripheral Blood Stem-Cell or Bone Marrow Transplantation Better than Conventional Chemotherapy ?
After more than three decades of clinical trials testing various st and ard-dose chemotherapy regimens , the disease course of patients with multiple myeloma has not changed appreciably .
Conventional chemotherapy can provide effective palliation but is not curative ( 1 ) .
Case series have described encouraging results in patients with myeloma undergoing allogeneic or autologous bone marrow or peripheral blood stem-cell transplantation ( 2 ) .
Other studies of transplantation , including r and omized trials , have been reported in the past 6 years ( 3 , 4 ) .
To facilitate decisions about treatment options , practice guidelines have been developed for use by health care providers and consumers .
In Ontario , Canada , cancer treatments and policies are led by a state-funded organization , Cancer Care Ontario .
To help derive treatment options , Cancer Care Ontario has developed the Program in Evidence -Based Care , which includes the Practice Guidelines Initiative .
To approach this topic , the DSG addressed the following questions : What is optimal st and ard-dose chemotherapy for patients with myeloma ?
When should transplantation be performed ?
Who should ( or should not ) receive a transplant ?