Other agents

• Bisphosphonates inhibit osteoclast activation; patients on long term therapy experience less bone pain and fewer new bone lesions and fractures; there is evidence of improved quality of life and possible prolongation of survival; as yet no evidence for superiority of either daily oral clodronate or monthly IV pamidronate/zoledronate.

• Interferon-a administered as maintenance therapy during plateau phase at a dose of 3mu/m2 SC tiw improves response duration on a meta-analysis (median 6 months) and has a small effect on survival; side effects reduce patient compliance and cost-utility profile is unfavourable.

• Cyclophosphamide (300-500mg PO/IV once weekly; 'C-weekly') may be used as a single agent for patients intolerant of melphalan due to persistent cytopenia and is capable of achieving durable plateau phase.

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