title: Reduced risk of bacterial infection in multiple myeloma patients with VAD regimen without intermittent high-dose dexamethasone.
abstract: Vincristine-adriamycin-dexamethasone (VAD) regimen with intermittent high-dose dexamethasone (HD) has been used as primary chemotherapy for multiple myeloma (MM) patients who are candidates for high-dose therapy or present with renal failure. However, dexamethasone increases the risk of infection in MM patients. We retrospectively evaluated treatment efficacy and infectious events in MM patients undergoing VAD with or without HD. Seventy-seven consecutive patients who received VAD without HD (n = 37) or VAD-HD (n = 40) at our institution were assessed. Characteristics of patients and VAD regimens were retrospectively analyzed to detect correlations with the incidence of infections. During 218 VAD cycles, 48 infectious episodes were documented in 39 patients. Of these, 32 episodes in 26 patients were severe (grade ≥ 3). By analyzing each patient, VAD-HD was associated with risk of all-grade and severe bacterial infection, while International Staging System stage ≥ 2 was independently correlated with severe bacterial infection. Response rates after two cycles were comparable between the 2 VAD regimens. In conclusion, risk of infection is lower in VAD without HD than in VAD-HD, and the clinical response is equivalent. VAD-HD should thus be avoided for MM patients with high risk of infection.
authors.affiliation: Department of Hematology, National Hospital Organization Nishigunma National Hospital, 2854 Kanai, Shibukawa, Gunma 377-8511, Japan. aisoda@netnngh.hosp.go.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Isoda
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Nakahashi
authors.forename: Momoko
authors.initials: M
authors.lastname: Mawatari
authors.forename: Akihiro
authors.initials: A
authors.lastname: Manaka
authors.forename: Morio
authors.initials: M
authors.lastname: Sawamura
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; 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* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D018931:Antineoplastic Agents, Hormonal; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin