VAD chemotherapy for refractory multiple myeloma

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Abstract
Summary: Thirty‐four patients with refractory multiple myeloma were treated with 4‐d continuous infusions of vincristine and adriamycin in combination with 4‐d pulsed high‐dose dexamethasone (VAD). Of 31 evaluable patients, 16 entered a complete remission (50%) and three a partial remission (10%). No difference in response rate was observed between primary refractory and relapsed patients. The median response duration was 9 months and the median survival of the responding patients was 12 months versus 4 months for the non‐responders. Ten patients have currently survived longer than 360 d, of which six are stable in complete remission without therapy. All responding patients showed a remarkable improvement of their performance status and 70% of these patients became pain‐free. Bacterial infection was the major complication and was probably due to the intensive corticosteroid programme. Severe myelosuppression was rarely observed. Irrespective of the response to VAD, a high β‐microglobulin of 4 μg/ml or more was a bad prognostic parameter. As early relapses were seen especially in this group of patients, in the patients with a plasma‐cell LI% of 3 or more, and in patients with previous anthracyclin treatment, early consolidation, with, for instance, high dose melphalan, might improve the prognosis for these patients.