Infused vincristine and adriamycin with high dose methylprednisolone (VAMP) in advanced previously treated multiple myeloma patients

Abstract

Summary Forty-five patients with relapsed or refractory multiple myeloma received continuous infusions of vincristine (0.4mg total dose daily for 4 days) and adriamycin (9mgm-2 daily for 4 days) with a high dose of methylprednisolone (1 gm-2 i.v. or p.o. daily by 1 h infusion), the VAMP regimen. Sixteen (36%) responded, with a median duration of remission of 11 months and median survival of 20 months. Major toxicities encountered were infective and cardiovascular. Two smaller groups of myeloma patients were treated with high dose methylprednisolone (HDMP) alone, or VAMP plus weekly low dose cyclophosphamide (Cyclo-VAMP). HDMP produced short responses in 25% of patients with less toxicity than VAMP. Cyclo-VAMP was used in a highly selected group of patients who had previously responded to high dose melphalan. It was well tolerated and produced responses in 61 % of this group.

Repeat administration of high dose melphalan in relapsed myeloma

“…It is noteworthy that this procedure is of value even in patients who do not respond to induction therapy: four patients subsequently achieved a complete remission and eight a partial response. However, this group has been specifically selected because of previous response to high dose chemotherapy and confirms our earlier report of high response rates in previously treated patients using cVAMP (Forgeson et al, 1988).…”

“…This compares favourably with the response duration achieved by responding patients who received VAMP alone (Forgeson et al, 1988). Patients treated with low dose melphalan before HDM have a universally short remission-free period (Selby et al, 1987) suggesting that a higher dose of melphalan does between first and second high dose melphalan.…”

“…This regimen consists of a 4 day continuous infusion of vincristine, doxorubicin and methylprednisolone (VAMP) given every 3 weeks, and has been used successfully in previously treated and untreated patients (Forgeson et al, 1988;Gore et al, 1989) to reduce tumour burden and the degree of marrow infiltration. In those patients in whom the marrow infiltration falls to less than 30% a higher dose of melphalan can then be given together with an autologous bone marrow transplant (ABMT), and this reduces the period of bone marrow suppression (McElwain et al, 1989).…”

The treatment of multiple myeloma-an important MRC trial

“…The finding that novel combinations employing infusional vincristine and adriamycin with high doses of either dexamethasone or methylprednisolone (VAD or VAMP) had significant activity in patients with disease resistant to alkylating agents (Barlogie et al, 1984;Forgeson et al, 1988) has led to these regimens increasingly being used as initial therapy. Although the remissions induced are no more durable than those following other types of conventional chemotherapy, the responses are rapid (Samson et al, 1989;Salmon & Crowley, 1992), and the use of these treatments for cytoreduction prior to high-dose treatment with alkylating agents has the theoretical advantage of non-crossresistance.…”

Vincristine, adriamycin and high dose steroids in myeloma complicated by renal failure

“…It is known to be a poor prognostic sign, with median survival of 13 months (MRC, 1984) or less (Cavo, 1986) compared to [30][31][32][33][34][35][36] months for myeloma as a whole (Editorial, 1988). In about half the patients renal failure is reversible following initial treatment (Pozzi, 1986;Rota, 1987) Infused vincristine and adriamycin with high dose steroids in the form of either dexamethasone (Barlogie, 1984) or methylprednisolone (Forgeson, 1988), is recognised to be effective therapy in myeloma and to be capable of causing a rapid reduction in paraprotein in responding patients. In view of these findings we have evaluated the use of such treatment in eight patients with myeloma complicated by renal failure which had not responded to rehydration.…”