Vincristine, doxorubicin, and dexamethasone or thalidomide plus dexamethasone for newly diagnosed patients with multiple myeloma?

Abstract

Multiple myeloma (MM) is a malignant plasma cell tumor that is distributed at multiple sites within the bone marrow compartments. High-dose dexamethasone regimens [including vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy] induce rapid responses, and have resulted in improved survival for many patients when followed by intensive therapy with autologous stem cell support early in the disease course. However, VAD have several disadvantages including the need for an intravenous indwelling catheter, which predisposes patients to catheter-related sepsis and thrombosis; most of the activity of VAD was from high-dose dexamethasone component. We enrolled all patients who fulfilled entire criteria for MM during the period between January 1997 and December 2005. The present study is a descriptive, retrospective, longitudinal, and observational one. The frequency of response (CR, VGPR/NCR, and PR) in the group of thalidomide and dexamethasone was 84.3% (CR 18.75% VGPR/NCR 18.75%, and PR 46.8%) being higher than VAD, 55% (CR 16%, VGPR/NCR 5%, and PR 34%). P = 0.0005. In summary, we conclude Thal/dex is an effective therapy in newly diagnosed MM inducing objective responses in over 84.3%.

Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of Thalidomide Plus Dexamethasone Compared With Dexamethasone As Initial Therapy for Newly Diagnosed Multiple Myeloma

“…[5][6][7] Some studies have reported the superiority of thal/dex compared with intravenous VAD based on short-term response rates. [8][9][10] In a recent randomized trial, the Eastern Cooperative Oncology Group (ECOG) found significantly higher response rates with thal/dex compared with dexamethasone alone following 4 months of therapy (63% versus 41%). 11 However, there was no data on longterm outcome measures, such as time to progression (TTP) and progression-free survival (PFS).…”

Primary Plasma Cell Leukemia Associated with Adult Fanconi Syndrome

“…The occurrence of renal failure in the major reported series of primary PCL is summarized in Table 1. [2][3][4][5] Plasma cell dyscrasia secreting free light chain, exclusively of g isotype, can be complicated by Fanconi syndrome. Fanconi syndrome is a generalized dysfunction of the proximal renal tubule characterized by glycosuria with normal glycemia, aminoaciduria, phosphaturia, uricosuria, and bicarbonaturia.…”

An open-label study of pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone combination therapy in newly diagnosed multiple myeloma patients in the Chinese population

“…Favorable results have been obtained with doxorubicin-based combination regimens [4][5][6][7][8][9][10] , such as VAD (vincristine, doxorubicin, and dexamethasone), which has response rates of 50%-80% in newly diagnosed patients and approximately 50% in patients with disease recurrence. The progression-free survival (PFS) for newly diagnosed patients treated with VAD is 9-12 months.…”

“…Therefore, increased exposure of MM patients to doxorubicin might improve response rates. Given the demonstrated effi cacy of VAD in MM patients [4][5][6][7][8][9][10] and the potential of PLD to extend the duration of bone marrow exposure to therapeutic levels of doxorubicin, a combination regimen of PLD, vincristine, and dexamethasone (DVd) could provide an advantage in the treatment of MM. We performed this study to evaluate the effi cacy and safety of the DVd regimen in the treatment of newly diagnosed MM patients in a Chinese population.…”