High early mortality rate in elderly patients with multiple myeloma receiving a vincristine-doxorubicin-dexamethasone regimen.
Treatment-related mortality (TRM) is not uncommon in patients after the first course of vincristine-doxorubicin-dexamethasone (VAD) chemotherapy,but quite rare after melphalan-prednisolone (MP). This motivated us to compare the rates of TRM after the first course of VAD with those after the first course of MP. We retrospectively assessed survival and TRM in 179 patients treated for multiple myeloma with either MP or VAD. Survival was similar in two groups (P 50.463 in log-rank test). However, TRM was significantly higher inpatients after the first course of VAD (11 in 100 patients, 11.0%) than that after the first course of MP (1 in 79, 1.3%; P 5 0.010). Poor performance status (P 5 0.004) and advanced age (P 5 0.009) before treatment were independent significant factors associated with TRM after the first course of induction therapy. Pyogenic infection was the major cause of TRM after VAD (9 in 11, 81.8%). We concluded that VAD should be cautiously used as induction therapy in multiple myeloma patients, especially in elderly and/or those with poor performance status.
Teng
Hao-Wei
HW
Teng
Chung-Jen
CJ
Wang
Wei-Shu
WS
Chen
Po-Min
PM
Chiou
Tzeon-Jye
TJ
Hsu
Hui-Chi
HC
Liu
Jin-Hwang
JH
Yen
Chueh-Chuan
CC
Hsiao
Liang-Tsai
LT
Yang
Muh-Hwa
MH
Chao
Ta-Chung
TC
Yang
Ya-Hsu
YH
Gau
Jyh-Pyng
JP
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D015994:Incidence; D007239:Infections / Q000401:mortality; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan; D011241:Prednisone