Potential value of vintristine-adriamycin-dexamethasone combination chemotherapy (VAD) in refractory and rapidly progressive myeloma.
10 patients with myeloma refractory to alkylating agents were treated with either 4-d pulses of high-dose dexamethasone therapy, or 4-d pulsed high-dose dexamethasone in combination with 4-d continuous infusions of vincristine and adriamycin (VAD). 8 patients were evaluated after a median duration of treatment of 2.3 courses (range 1 to 4). 6 of the 8 evaluable patients achieved reduction in serum and/or urine paraprotein levels with a mean reduction in serum paraprotein of 74.1%. There was a concomitant improvement in wellbeing in these responding patients. 2 evaluable patients failed to show biochemical or clinical response (1 treated with VAD, 1 high-dose dexamethasone). 2 patients currently survive 390 d and 180 d, respectively, on continuing therapy. 8 patients died with a mean duration of survival of 99 d (range 10 to 246 d). We conclude that the use of VAD chemotherapy in patients with refractory myeloma confers both a worthwhile remission of disease symptoms and biochemical evidence of disease regression, and that trials of VAD as primary treatment for myeloma are indicated.
Collin
R
R
Department of Haematology, Royal Hallamshire Hospital, Sheffield, U.K.
Greaves
M
M
Preston
F E
FE
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001772:Blood Cell Count / Q000187:drug effects; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D004341:Drug Evaluation; D006801:Humans; D007239:Infections / Q000150:complications; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin