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Summary.

276 patients suffering from myelomatosis who had not received chemotherapy were allocated at random to receive either melphalan or cyclophosphamide on a continuous basis at low daily dosage and the prognostic significance of 21 presenting features has been analysed in 258 cases. The period of follow-up was between 34 and 80 mth.

The blood urea concentration (BUC) was the most important single factor influencing the prognosis (P<0.001). The relative death rate of the subgroup of 53 patients whose blood urea concentration was 80 mg/100 ml or more was five times greater than that of the 113 patients whose blood urea concentration was less than 40 mg/100 ml. The median survival times of the two subgroups were z and 37 mth. The concentration of high-molecular weight protein in the urine (HMWP) was correlated both with the BUC and with prognosis after allowing for the BUC; the relative death rate for patients with proteinuria of 40 mg/100 ml or more was about twice that of patients with less proteinuria at all urea concentrations. The serum albumin concentration (SAC) was correlated with prognosis independently of the BUC and of the HMWP (P<0.01). Throughout the range of albumin concentration, the prognosis improved with increasing concentration. The relative death rate of patients whose SAC was below 3 g/100 ml was about twice that of patients whose SAC was 4 g/100 ml or more.

The haemoglobin concentration and the BUC were strongly correlated with one another, but the haemoglobin concentration was adversely correlated with prognosis (P<0.01) independently of the BUC. For those patients whose haemoglobin concentration was below 7.5 g/100 ml the relative death rate was about twice that of patients whose haemoglobin concentration was above 9 g/100 ml. The effect of many other factors was also examined but none was significantly correlated with the prognosis after adjustment for renal failure had been made.