Cumulative exposure to melphalan, however, is associated with increased risk of marrow toxicity, including myelodysplasia, acute leukemia, and impaired stem cell production. This is an important consideration in people who are candidates for autologous stem cell transplants. The addition of anthracyclines, alternative alkylating agents, and interferon has yielded minimal improvement in treatment outcomes. Although the incorporation of new classes of medications in the treatment of multiple myeloma has seen a shift in the older treatment regimens, the conventional approaches have not been excluded.
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