There is controversy about whether newly diagnosed patients should receive conventional chemotherapy or high dose chemotherapy (i.e. bone marrow transplant) the NCI makes the following observations: Chemotherapy prolongs the survival of patients with symptomatic myeloma to a median of 40 to 46 months for patients with stage I disease, 35 to 40 months for patients with stage II disease, and 24 to 30 months for patients with stage III disease. A  well-tolerated chemotherapy regimen producing consistent results is melphalan and prednisone (MP). Other regimens appear to produce similar survival outcomes. The Intergroupe Francais du Myelome randomized 200 previously untreated myeloma patients under 65 years of age to treatment with conventional chemotherapy versus high-dose therapy. Survival and disease-free survival were significantly improved in the high-dose arm (the estimated 5-year survival was 52% versus 12%; the estimated 5-year event-free survival was 28% versus 10%). Relapses, however, continue to occur at a constant rate, so that at 5 years, only 28% of those receiving high-dose therapy, and 10% of those on conventional chemotherapy have not relapsed. Event-free survival is significantly better for the high-dose group but there is no sign of a slowing in the relapse rate, or a plateau, to suggest that any of these patients have been cured. While this study suggests that myeloablative therapy with autologous transplant may prolong survival for patients with multiple myeloma, the finding requires confirmation by the current ongoing intergroup study comparing standard therapy to high-dose options. Also see NCCN position on the role for marrow transplant therapy.