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From the UpToDate article on multiple myeloma:

In most people, chemotherapy partially controls multiple myeloma; rarely, chemotherapy leads to complete remission.

Also:

Transplantation, when successful, prolongs survival, leads to a remission, and, infrequently, cures multiple myeloma. However, transplantation has several limitations. The high-dose chemotherapy given before transplantation usually fails to kill all of the plasma cells, allowing the condition to relapse after transplantation. Such treatment also puts the patient at risk for serious infections and bleeding, which can be fatal.

UpToDate is used by 700,000+ physicians worldwide; it's not alternative medicine. Thus, if even mainstream medicine recognizes the relative ineffectiveness of chemo and transplantation for multiple myeloma, why do they do it?

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  • $\begingroup$ This is really a question about healthcare, not about biology and it is off-topic here. $\endgroup$ – Mad Scientist Feb 22 '14 at 20:18
  • $\begingroup$ @MadScientist Is there a healthcare StackExchange or something equivalent? thanks $\endgroup$ – Geremia Feb 22 '14 at 22:42
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To long for a comment: Its more an ethical thing I would say. I do research which is connected to melanoma - a cancer which is notoriously treatment resistant, once it started moving. Until very recently there was only one chemotherapeuticum which has pretty low (around 20%) response rates. It was usually tried anyway because its possible that the patients belong to this 20% which respond. If not, treatment was usually not prolonged.

I think its something similiar here. The other problem for chemotherapy is that it is cytotoxic (until we got the small molecule inhibitors which are tested and used today) and the problem is to kill the cancer cells (all when possible) while you leave the rest of the body as unaffected as possible. To get this balance is hard (people tend to react differently to chemotherapy). The other problem is that cancers are not homogenous. So its possible that 99.9% of the cells present respond to chemotherapy and get killed, while a few acquired an additional mutation, which gives them an advantage. The conditions of chemotherapy are very selective.

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  • $\begingroup$ I know that 97% of multiple myeloma patients have anemia, but do you know if chemo causes anemia? $\endgroup$ – Geremia Feb 22 '14 at 19:59

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