title: VAD chemotherapy for refractory multiple myeloma.
abstract: Thirty-four patients with refractory multiple myeloma were treated with 4-d continuous infusions of vincristine and adriamycin in combination with 4-d pulsed high-dose dexamethasone (VAD). Of 31 evaluable patients, 16 entered a complete remission (50%) and three a partial remission (10%). No difference in response rate was observed between primary refractory and relapsed patients. The median response duration was 9 months and the median survival of the responding patients was 12 months versus 4 months for the non-responders. Ten patients have currently survived longer than 360 d, of which six are stable in complete remission without therapy. All responding patients showed a remarkable improvement of their performance status and 70% of these patients became pain-free. Bacterial infection was the major complication and was probably due to the intensive corticosteroid programme. Severe myelosuppression was rarely observed. Irrespective of the response to VAD, a high beta 2-microglobulin of 4 micrograms/ml or more was a bad prognostic parameter. As early relapses were seen especially in this group of patients, in the patients with a plasma-cell LI% of 3 or more, and in patients with previous anthracyclin treatment, early consolidation, with, for instance, high dose melphalan, might improve the prognosis for these patients.
authors.affiliation: Department of Haematology, University Hospital, Utrecht, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Lokhorst
authors.forename: O J
authors.initials: OJ
authors.lastname: Meuwissen
authors.forename: E J
authors.initials: EJ
authors.lastname: Bast
authors.forename: A W
authors.initials: AW
authors.lastname: Dekker
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D010950:Plasma Cells / Q000187:drug effects; D014750:Vincristine / Q000627:therapeutic use; D001613:beta 2-Microglobulin / Q000032:analysis
chemical_list: D001613:beta 2-Microglobulin; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin