title: The VAD-DCEP sequence is an effective pre-transplant therapy in untreated multiple myeloma.
abstract: OBJECTIVE
  Standard treatment for patients with multiple myeloma is debulking chemotherapy with non-alkylating agents followed by a regimen to mobilize peripheral blood stem cells (PBSC) and the transplantation of the mobilized, autologous PBSC. The aim of this study was to evaluate the efficacy of a new regimen and compare it with that of a previous regimen.
  
  
  METHODS
  In a large cohort of 106 patients (group I) we administered a new pre-transplant program which includes 2 courses of pulsed-VAD (vincristine, adriamycin, dexamethasone) followed by 2 courses of DCEP (dexamethasone, cyclophosphamide, etoposide and cis-platinum). We compared the efficacy of this new VAD-DCEP sequence, in terms of mobilizing capacity, toxicity and anti-myeloma activity in comparison with that of the previous VAD-high-dose cyclophosphamide program (group II, 40 patients).
  
  
  RESULTS
  In group I 81/106 (76.4%) patients yielded >or= 4x10(6)/kg CD34+ cells, as did 30/40 (75%) in group II but with a significantly higher toxicity in this latter group. In detail, 9 patients in group I (8.5%) had WHO grade III neutropenia versus 35 in group II (87.5%), 5 patients of group I (4.7%) had grade III thrombocytopenia versus 12 patients in group II (30%), and 8 patients in group I (7.5%) experienced an infections fever versus 9 patients in group II (22.5%). Therefore, nearly all patients in group II had to be admitted to hospital (39/40, 97.5%). There was a higher percentage of responses (CR+VGPR+PR) in group I than in group II: 73% versus 50% (p=0.02).
  
  
  CONCLUSIONS
  the VAD-DCEP sequence has an adequate mobilizing capacity, without significant toxicity, and a good anti-myeloma activity, and therefore represents a safe and effective therapeutic approach for multiple myeloma patients at the onset of their disease.
authors.affiliation: The Division of Hematology from IRCCS Policlinico S. Matteo University of Pavia, Ospedale Niguarda Milano, Italy. a.corso@smatteo.pv.it <a.corso@smatteo.pv.it>
authors.forename: Alessandro
authors.initials: A
authors.lastname: Corso
authors.forename: Luciana
authors.initials: L
authors.lastname: Barbarano
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zappasodi
authors.forename: Roberto
authors.initials: R
authors.lastname: Cairoli
authors.forename: Emilio Paolo
authors.initials: EP
authors.lastname: Alessandrino
authors.forename: Silvia
authors.initials: S
authors.lastname: Mangiacavalli
authors.forename: Daris
authors.initials: D
authors.lastname: Ferrari
authors.forename: Sergio
authors.initials: S
authors.lastname: Fava
authors.forename: Mario
authors.initials: M
authors.lastname: Fiumanò
authors.forename: Guido
authors.initials: G
authors.lastname: Frigerio
authors.forename: Luciano
authors.initials: L
authors.lastname: Isa
authors.forename: Annalisa
authors.initials: A
authors.lastname: Luraschi
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Alberto
authors.initials: A
authors.lastname: De Paoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Vergani
authors.forename: Luciano
authors.initials: L
authors.lastname: Banfi
authors.forename: Daniele
authors.initials: D
authors.lastname: Perego
authors.forename: Gianni
authors.initials: G
authors.lastname: Ucci
authors.forename: Graziella
authors.initials: G
authors.lastname: Pinotti
authors.forename: Maria
authors.initials: M
authors.lastname: Savarè
authors.forename: Lilj
authors.initials: L
authors.lastname: Uziel
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vismara
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.forename: Mario
authors.initials: M
authors.lastname: Lazzarino
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009503:Neutropenia / Q000139:chemically induced; D013921:Thrombocytopenia / Q000139:chemically induced; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D008558:Melphalan