Objective: The objective of the investi ation is evaluation of therapeutic results and the development of the pro nosis of patients with multiple myeloma (MM) as a result of consecutive chan es of therapeutic procedures in patients of central and northern Moravia in the course of the last 40 years. Methods and results: The analyzed group of 562 patients with MM was concentrated at the Ist and IIIrd Medical Clinic of the Faculty Hospital Olomouc in 1959 - 2000, median age 63 (28-91) male/female ratio 1.1: 1.0. From analysis of Kaplan-Meier survival curves and the results of statistical analysis (log rank test p = 0.0000) ensued that during the evaluated period a very substantial change of the prognosis occurred with improvement of therapeutic results and a significant prolongation of survival in general. The first "turning point" was the introduction of chemotherapy with alkylating substances with Prednisone (1963 - l975), leading as compared with the period of symptomatic treatment alone (1959 - 1063) to a significant prolongation of the median value of general survival (M) from 8 to 19 months (p = 0.0031) and 3-year survival from 4 to 23 % patients, whereby 10-year survival was only 0 % and 1 %. The second "turning point" was the period from 1976 - 1980 with introduction of systematic chemotherapy using conventional doses of polychemotherapeutic (CP) regimes with better opportunities of supporting treatment (M = 40 months, p = 0.0000; 3-year and 10-year survival 55% and 5.5% patients). The therapeutic results achieved during the subsequent 15 years were however an unsatisfactory advance. During the interval between 1976-1995 in a group of 295 patients divided into 5-year sub-periods remission was achieved (R = < 25 % of the baseline value of M-protein) in 10-24 % patients, an inadequate response (NR) = persistence in > 50 % M-protein) in 55-28 %, prolongation of the median of total survival in 232 of the assessable patients for 44 months and long-term survival of 5 - 10 years after establishment of the diagnosis increased from 25 to 36 % and from 5.5 to 16.5 % patients. The third "turning point" was 1996 characterized by the introduction of high-dosage chemotherapy with transplantation of autologous peripheral haematopoietic cells ("HD" therapy with ASCT) leading in a group of so far only 33 assessable patients under 65 years to achieved remission in 71 %, to a decline of NR in 10 % only and 5 -year survival so far in 91% patients (p = 0.0037). Improvement of therapeutic results and prognosis of the disease as compared with 1976 - 1995 occurred in the whole group of patients also in 1996 - 2000 (CP and "HD"-therapy with ASCT) characterized by remission in 36 %, NR in 33 % and 5-year survival in 57 % (p = 0.030). It was revealed that the application of "HD" therapy with ASCT led in 1995-2000 to the achievement of more favourable therapeutic results (R - 71 % NR - 10 %. 5-year survival after the interval which elapsed so far 91 %), as compared with 2 similar groups of subjects under 65 years meeting the criteria of "HD" therapy with ASCT, but treated only by conventional polychemotherapy (1991 - 1995 and 1996 - 2000: R - 24 and 32 %, NR - 42 and 23 %, 5-year survival 46 and 68 % of the patients). In the group of 148 patients from the period of 1991-2000 the patients had as regards remission (R) more favourable results as compared with patients with NR concerning the prognosis [M 63 vs.22 months, 5-year and 10-year survival 53 vs. 17 % and 17 vs. 0 % of patients (p = 0.0000)]. Conclusion: From the submitted analysis ensued that durin the period from 1959 - 2000 in patients with multiple myeloma in central and northern Moravia as a result of the application of modern methods of chemotherapy and supportin treatment a si nificant improvement of results of conventional treatment occurred with a more than 5 fold prolon ation of so far assessable median values of survival (8 - 44 months) and lon -term 10-year survival of almost one sixth of the patients. The real asset of "HD" therapy with transplantation of ASCT will be revealed by analyses made after a lon er time interval.

        Key words: Conventional polychemotherapy - Hi h-dose/myeloablation chemotherapy - Trans-plantation of autologous peripheral haematopoietic cells - Therapeutic results - Prognosis