Infusion of Vincristine and Doxorubicin With Oral Dexamethasone as First-Line Therapy for Multiple Myeloma

Single agent dexamethasone for pre-stem cell transplant induction therapy for multiple myeloma

“…12 Different combination regimens have been used for induction therapy in these patients, the most common one being the combination of vincristine, doxorubicin, and dexamethasone (VAD), which was initially introduced in the mid eighties. 17,18 Given that dexamethasone is the most active component in the combination and based on reports of efficacy of dexamethasone used alone in myeloma, [19][20][21] as well as the known adverse effects with VAD, we treated a group of patients with single agent dexamethasone as induction therapy.…”

“…13,17,18 Adverse events seen with VAD include myelosuppression, increased risk of deep vein thrombosis, neuropathy due to vincristine, sepsis and thrombotic phenomena from indwelling catheter, as well as potential cardiotoxicity due to doxorubicin. 17,18,22 In addition, it involves continuous infusion of adriamycin and vincristine over 4 days necessitating central venous access and possible hospitalization. The concept behind the VAD combination was the dose responsiveness of myeloma to dexamethasone as well as targeting of the slow cycling plasma cells with continuous infusion of doxorubicin and vincristine.…”

“…The response rate to dexamethasone is comparable to that seen with the control population receiving VAD, which in turn appears to be similar to that reported with VAD in newly diagnosed myeloma. 17 Given these results, single agent dexamethasone appears to be an effective alternative to VAD as initial therapy for patients with newly diagnosed myeloma, proceeding to autologous stem cell transplantation. In fact, at our institution, newly diagnosed patients eligible for HDT are started on dexamethasone induction therapy if they are not participating in a clinical trial.…”

TRAIL-induced eradication of primary tumour cells from multiple myeloma patient bone marrows is not related to TRAIL receptor expression or prior chemotherapy

“…Aggressive chemotherapy has been shown to be associated with a greater likelihood of achieving an initial 'plateau' phase (70-80%) but is associated with only a marginal survival advantage compared to less intensive chemotherapy. 2 High-dose chemoradiotherapy supported with autologous bone marrow transplantation (ABMT) has been shown, in a randomised multicentre trial, to improve complete remission (CR) rates and survival when compared to standard-dose chemotherapy. 3 Based on this observation high-dose therapy is being increasingly utilised as first-line therapy in younger (age Ͻ70 years) MM patients.…”

The treatment of multiple myeloma-an important MRC trial

“…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.…”