title: Bortezomib, doxorubicin and dexamethasone in advanced multiple myeloma.
abstract: BACKGROUND
  Bortezomib has shown significant activity in myeloma. In this multicenter trial, we assessed for the first time the combination of bortezomib, doxorubicin and low-dose dexamethasone (PAd) in the treatment of relapsed/refractory myeloma.
  
  
  METHODS
  Sixty-four patients were treated for a median of four 28-day cycles (1-6). Bortezomib was given at 1.3 mg/m(2) (days 1, 4, 8, 11) and dexamethasone at 40 mg (days 1-4); 34 patients receive doxorubicin at 20 mg/m(2) (days 1, 4) while 30 patients pegylated liposomal doxorubicin at 30 mg/m(2) (day 1).
  
  
  RESULTS
  Fifty-eight percent of patients had undergone prior autologous transplantation, 70% prior anthracycline and 27% prior bortezomib-based regimens. Forty-three patients (67%) achieved at least a partial response including 16 (25%) with at least a very good partial response. One-year event-free survival was 34% after PAd and 31% after the previous line of therapy (hazard ratio 1.20, 95% confidence interval 0.76-1.90, P = 0.43). One-year overall survival from the start of PAd was 66%. Grade 3-4 toxic effects included thrombocytopenia (48%), neutropenia (36%), infections (15%), anemia (13%), gastrointestinal disturbances (11%) and peripheral neuropathy (10%). Two patients had grade 3-4 cardiac heart failure.
  
  
  CONCLUSIONS
  PAd is an active salvage therapy with manageable toxicity in patients with relapsed/refractory myeloma.
authors.affiliation: Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy. appalumbo@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Palumbo
authors.forename: F
authors.initials: F
authors.lastname: Gay
authors.forename: S
authors.initials: S
authors.lastname: Bringhen
authors.forename: A
authors.initials: A
authors.lastname: Falcone
authors.forename: N
authors.initials: N
authors.lastname: Pescosta
authors.forename: V
authors.initials: V
authors.lastname: Callea
authors.forename: T
authors.initials: T
authors.lastname: Caravita
authors.forename: F
authors.initials: F
authors.lastname: Morabito
authors.forename: V
authors.initials: V
authors.lastname: Magarotto
authors.forename: M
authors.initials: M
authors.lastname: Ruggeri
authors.forename: I
authors.initials: I
authors.lastname: Avonto
authors.forename: P
authors.initials: P
authors.lastname: Musto
authors.forename: N
authors.initials: N
authors.lastname: Cascavilla
authors.forename: B
authors.initials: B
authors.lastname: Bruno
authors.forename: M
authors.initials: M
authors.lastname: Boccadoro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D011719:Pyrazines / Q000008:administration & dosage; D016879:Salvage Therapy
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin