A randomized study comparing VMCP and MMPP in the treatment of multiple myeloma

Nagura, Eiichi; Ichikawa, Atsushi; Kamiya, O; Kato, Ryuichi; Utsumi, Makoto; Tanaka, Masao; Takeyama, Hideo; Shimizu, Kazuyuki; Kobayashi, Masahide; Kurio, Naito; Nishiwaki, Hiroshi; Mizuno, Harumitsu; Hirabayashi, N; Nitta, Masakazu; Kato, Y; Shibata, Toshihiko; Hotta, Tomomitsu; Kawashima, Kohei; Saito, Hidehiko

doi:10.1007/s002800050573

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…Daratumumab has been used at a shorter interval, weekly in cycle 1 and 2 of some regimens [ 24 , 28 ]. Methotrexate was omitted because of its low efficacy in myeloma, while vincristine and procarbazine were retained because of their anti-myeloma activity [ 29 ]. IT methotrexate was omitted, again, for the same reason.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Leptomeningeal Myelomatosis and Rapid Improvement with Regimen Consisting of Daratumumab, Pomalidomide, Vincristine, Procarbazine, and Dexamethasone

Kuan

Chai²,

Rajadurai

et al. 2022

Case Reports in Hematology

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Central nervous system (CNS) involvement in multiple myeloma (MM) (MM-CNS) in the form of leptomeningeal myelomatosis or brain parenchyma plasmacytoma is rare, causing challenges in clinical diagnosis and treatment. We would like to report a case of leptomeningeal myelomatosis and illustrated the challeges. A 61-year-old man was diagnosed with MM with left paravertebral plasmacytoma, R-ISS II with high suspicion of double-hit MM, either biallelic aberrancy of TP53 or del(17p) and IGH aberrancy depending on the definition chosen, treated with lenalidomide-bortezomib-dexamethasone and local radiotherapy, later developed systemic relapse and progression to MM-CNS in the form of leptomeningeal myelomatosis. A modified CNS-based treatment not reported before, consisting of daratumumab, pomalidomide, vincristine, procarbazine, and dexamethasone, brought a rapid clinical improvement and warrants a further study. Incorporation of intrathecal thiotepa into the regimen would likely increase the efficacy.

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Section: Discussionmentioning

confidence: 99%

A Case Report of Leptomeningeal Myelomatosis and Rapid Improvement with Regimen Consisting of Daratumumab, Pomalidomide, Vincristine, Procarbazine, and Dexamethasone

Kuan

Chai²,

Rajadurai

et al. 2022

Case Reports in Hematology

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“…Studies have shown that procarbazine (a plant sesquiterpene lactone) induces myeloma cell apoptosis by mechanisms that involves ROS or by inhibiting NF-κB and caspasedependent and -independent pathways (Suvannasankha et al, 2008). Procarbazine generates H 2 O 2 during oxidation to its azo derivative (Berneis et al, 1963), has been incorporated in a combination chemotherapy called MMPP (ranimustine, melphalan, procarbazine and prednisolone) however this regimen did not show superior chemotherapy over MMCP (with cyclophosphamide) in MM (Nagura et al, 1997). It has been shown that these compounds can induce Nrf2/antioxidant response element pathway and antioxidant enzymes resulting in increased resistance to oxidative damage (Umemura et al, 2008).…”

Section: Myeloma and Lymphoma Cells Harbor Ras Mutations And Respond mentioning

confidence: 99%

Enhancing Therapeutic Radiation Responses in Multiple Myeloma

Salem¹,

Goel²

2012

Modern Practices in Radiation Therapy

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“…We subsequently reported another randomized study employing MMPP [ranimustine (MCNU), MPH, procarbazine (PCZ) and PSL] and VMCP and disclosed that patients who attained plateau phase had a significantly longer survival than those who d id not (7).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with indolent or smoldering myeloma were excluded from the study. The same exclusion criteria had been applied to the previous randomized study of VMCP and MMPP (7). Informed consent was obtained prior to enrollment.…”

Section: Introductionmentioning

confidence: 99%

Superior Efficacy of MMCP Regimen Compared with VMCP and MMPP Regimens in the Treatment of Multiple Myeloma.

et al. 2002

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Objective A newly designed combination chemotherapy for multiple myeloma, MMCP [ranimustine (MCNU), melphalan (MPH), cyclophosphamide (CPM) and prednisolone (PSL)], was analyzed and compared with the results of our previous randomized trial of VMCP [vincristine, MPH, CPM and PSL] and MMPP [MCNU, MPH, procarbazine and PSL]. Methods MCNU (33.3 mg/m2, div) on day 1 and MPH (4 mg/m2, po), CPM (66.7 mg/m2, po) and PSL (30 mg/m2, po) from day 1 to 4, were administered. Each cycle was repeated every 3 weeks. Patients or materials From January 1991 until August 1995, 104 patients with multiple myeloma diagnosed at 10 hospitals of Nagoya Cooperative Study Group were enrolled.Results Of the 87 evaluable patients, partial response rate for MMCP was 65.5% and was significantly higher than that ofVMCP (13/47=27.7%, p<0.0001) and that of MMPP (21/47=44.7 % , p=0.0196). A plateau attainment was observed in 49.4%. The percentage of the patients who attained plateau was significantly increased in the MMCP arm than in the VMCP arm (19.1%, p=0.0017) but was not in comparison with that of MMPP arm (42.6%, p=0.6790). Patients treated with MMCP survived significantly longer than those treated with VMCP or MMPP (p=0.0009 by generalized Wilcoxon test, p=0.0023 by log-rank test) with median survival for MMCP being 31.6 months, for VMCP 22.5 months, and for MMPP 22.9 months. No significant differences were observed with respect to adverse effects among the three regimens.Conclusion The newly designed MMCP is a candidate as an induction chemotherapy for multiple myeloma. (Internal Medicine 41: 290-294, 2002)

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A randomized study comparing VMCP and MMPP in the treatment of multiple myeloma

Abstract: We conclude that VMCP is less effective for myeloma than MMPP as the induction treatment, that alternating noncrossresistant chemotherapeutic combinations do not offer an advantage in multiple myeloma, and that patients who reach a plateau phase have a significantly longer survival time.

Cited by 7 publications

References 13 publications

A Case Report of Leptomeningeal Myelomatosis and Rapid Improvement with Regimen Consisting of Daratumumab, Pomalidomide, Vincristine, Procarbazine, and Dexamethasone

A Case Report of Leptomeningeal Myelomatosis and Rapid Improvement with Regimen Consisting of Daratumumab, Pomalidomide, Vincristine, Procarbazine, and Dexamethasone

Enhancing Therapeutic Radiation Responses in Multiple Myeloma

Superior Efficacy of MMCP Regimen Compared with VMCP and MMPP Regimens in the Treatment of Multiple Myeloma.

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