Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1995 Feb;71(2):326–330. doi: 10.1038/bjc.1995.65

VAD chemotherapy as remission induction for multiple myeloma.

H Anderson 1, J H Scarffe 1, M Ranson 1, R Young 1, G S Wieringa 1, G R Morgenstern 1, L Fitzsimmons 1, D Ryder 1
PMCID: PMC2033610  PMID: 7841049

Abstract

A total of 142 patients with multiple myeloma received VAD as remission induction therapy. Seventy-five were previously untreated and 67 had relapsed (31) or refractory disease (36). Vincristine (total dose 1.6 mg) was infused with doxorubicin 36 mg m-2 by continuous ambulatory pump over 4 days. In addition, oral dexamethasone 40 mg day-1 was given for 4 days. Intermittent dexamethasone was only given to 19 patients. Courses were repeated every 21 days. The overall response rate was 84% [27% complete response (CR)] in previously untreated patients and 61% (3% CR) in patients with relapsed and refractory disease. The median survival was 36 months for untreated patients and 10 months for those who had received prior therapy. VAD was well tolerated; however, despite prophylaxis, 54% patients received antibiotics at some time during therapy and 37% had dyspepsia. Twenty-three patients subsequently received a transplant (eight allografts, eight marrow autografts and seven peripheral blood stem cell transplants). Eight have died-four in the allogeneic group and four in the autologous group. The overall median survival of transplanted patients has not yet been reached. VAD is an effective, out-patient therapy for inducing remission in multiple myeloma. Post-remission therapy needs to be optimised, but it is likely that the needs of previously untreated patients may be different from those with relapsed and refractory disease.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexanian R., Barlogie B., Dixon D. High-dose glucocorticoid treatment of resistant myeloma. Ann Intern Med. 1986 Jul;105(1):8–11. doi: 10.7326/0003-4819-105-1-8. [DOI] [PubMed] [Google Scholar]
  2. Anderson H., Scarffe J. H., Lambert M., Smith D. B., Chan C. C., Chadwick G., McMahon A., Chang J., Crowther D., Swindell R. VAD chemotherapy--toxicity and efficacy--in patients with multiple myeloma and other lymphoid malignancies. Hematol Oncol. 1987 Jul-Sep;5(3):213–222. doi: 10.1002/hon.2900050308. [DOI] [PubMed] [Google Scholar]
  3. Attal M., Huguet F., Schlaifer D., Payen C., Laroche M., Fournie B., Mazieres B., Pris J., Laurent G. Intensive combined therapy for previously untreated aggressive myeloma. Blood. 1992 Mar 1;79(5):1130–1136. [PubMed] [Google Scholar]
  4. Barlogie B., Smith L., Alexanian R. Effective treatment of advanced multiple myeloma refractory to alkylating agents. N Engl J Med. 1984 May 24;310(21):1353–1356. doi: 10.1056/NEJM198405243102104. [DOI] [PubMed] [Google Scholar]
  5. Browman G. P., Belch A., Skillings J., Wilson K., Bergsagel D., Johnston D., Pater J. L. Modified adriamycin-vincristine-dexamethasone (m-VAD) in primary refractory and relapsed plasma cell myeloma: an NCI (Canada) pilot study. The National Cancer Institute of Canada Clinical Trials Group. Br J Haematol. 1992 Nov;82(3):555–559. doi: 10.1111/j.1365-2141.1992.tb06466.x. [DOI] [PubMed] [Google Scholar]
  6. Durie B. G., Salmon S. E. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975 Sep;36(3):842–854. doi: 10.1002/1097-0142(197509)36:3<842::aid-cncr2820360303>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  7. Gahrton G., Tura S., Ljungman P., Belanger C., Brandt L., Cavo M., Facon T., Granena A., Gore M., Gratwohl A. Allogeneic bone marrow transplantation in multiple myeloma. European Group for Bone Marrow Transplantation. N Engl J Med. 1991 Oct 31;325(18):1267–1273. doi: 10.1056/NEJM199110313251802. [DOI] [PubMed] [Google Scholar]
  8. Gore M. E., Selby P. J., Viner C., Clark P. I., Meldrum M., Millar B., Bell J., Maitland J. A., Milan S., Judson I. R. Intensive treatment of multiple myeloma and criteria for complete remission. Lancet. 1989 Oct 14;2(8668):879–882. doi: 10.1016/s0140-6736(89)91548-1. [DOI] [PubMed] [Google Scholar]
  9. Gregory W. M., Richards M. A., Malpas J. S. Combination chemotherapy versus melphalan and prednisolone in the treatment of multiple myeloma: an overview of published trials. J Clin Oncol. 1992 Feb;10(2):334–342. doi: 10.1200/JCO.1992.10.2.334. [DOI] [PubMed] [Google Scholar]
  10. Jonsson B., Nilsson K., Nygren P., Larsson R. SDZ PSC-833--a novel potent in vitro chemosensitizer in multiple myeloma. Anticancer Drugs. 1992 Dec;3(6):641–646. doi: 10.1097/00001813-199212000-00013. [DOI] [PubMed] [Google Scholar]
  11. Klein B., Zhang X. G., Jourdan M., Boiron J. M., Portier M., Lu Z. Y., Wijdenes J., Brochier J., Bataille R. Interleukin-6 is the central tumor growth factor in vitro and in vivo in multiple myeloma. Eur Cytokine Netw. 1990 Oct-Nov;1(4):193–201. [PubMed] [Google Scholar]
  12. MacLennan I. C., Chapman C., Dunn J., Kelly K. Combined chemotherapy with ABCM versus melphalan for treatment of myelomatosis. The Medical Research Council Working Party for Leukaemia in Adults. Lancet. 1992 Jan 25;339(8787):200–205. doi: 10.1016/0140-6736(92)90004-m. [DOI] [PubMed] [Google Scholar]
  13. Mandelli F., Avvisati G., Amadori S., Boccadoro M., Gernone A., Lauta V. M., Marmont F., Petrucci M. T., Tribalto M., Vegna M. L. Maintenance treatment with recombinant interferon alfa-2b in patients with multiple myeloma responding to conventional induction chemotherapy. N Engl J Med. 1990 May 17;322(20):1430–1434. doi: 10.1056/NEJM199005173222005. [DOI] [PubMed] [Google Scholar]
  14. Miller A. B., Hoogstraten B., Staquet M., Winkler A. Reporting results of cancer treatment. Cancer. 1981 Jan 1;47(1):207–214. doi: 10.1002/1097-0142(19810101)47:1<207::aid-cncr2820470134>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  15. Palumbo A., Boccadoro M., Garino L. A., Gallone G., Frieri R., Pileri A. Multiple myeloma: intensified maintenance therapy with recombinant interferon-alpha-2b plus glucocorticoids. Eur J Haematol. 1992 Aug;49(2):93–97. doi: 10.1111/j.1600-0609.1992.tb00037.x. [DOI] [PubMed] [Google Scholar]
  16. Pettengell R., Morgenstern G. R., Woll P. J., Chang J., Rowlands M., Young R., Radford J. A., Scarffe J. H., Testa N. G., Crowther D. Peripheral blood progenitor cell transplantation in lymphoma and leukemia using a single apheresis. Blood. 1993 Dec 15;82(12):3770–3777. [PubMed] [Google Scholar]
  17. Samson D., Gaminara E., Newland A., Van de Pette J., Kearney J., McCarthy D., Joyner M., Aston L., Mitchell T., Hamon M. Infusion of vincristine and doxorubicin with oral dexamethasone as first-line therapy for multiple myeloma. Lancet. 1989 Oct 14;2(8668):882–885. doi: 10.1016/s0140-6736(89)91549-3. [DOI] [PubMed] [Google Scholar]
  18. San Miguel J. F., Moro M., Bladé J., Guerras L., Hernandez J., Jimenez-Galindo R., Ortega F., Gonzalez M. Combination of interferon and dexamethasone in refractory multiple myeloma. Hematol Oncol. 1990 Jul-Aug;8(4):185–189. doi: 10.1002/hon.2900080403. [DOI] [PubMed] [Google Scholar]
  19. Selby P. J., McElwain T. J., Nandi A. C., Perren T. J., Powles R. L., Tillyer C. R., Osborne R. J., Slevin M. L., Malpas J. S. Multiple myeloma treated with high dose intravenous melphalan. Br J Haematol. 1987 May;66(1):55–62. doi: 10.1111/j.1365-2141.1987.tb06890.x. [DOI] [PubMed] [Google Scholar]
  20. Ventura G. J., Barlogie B., Hester J. P., Yau J. C., LeMaistre C. F., Wallerstein R. O., Spinolo J. A., Dicke K. A., Horwitz L. H., Alexanian R. High dose cyclophosphamide, BCNU and VP-16 with autologous blood stem cell support for refractory multiple myeloma. Bone Marrow Transplant. 1990 Apr;5(4):265–268. [PubMed] [Google Scholar]
  21. Woodruff R. Treatment of multiple myeloma. Cancer Treat Rev. 1981 Dec;8(4):225–270. doi: 10.1016/s0305-7372(81)80010-2. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES