Impact of early response to sequential high-dose chemotherapy on outcome of patients with advanced myeloma and poor prognostic features

Leuk Lymphoma. 2002 Mar;43(3):607-12. doi: 10.1080/10428190210324.

Abstract

We report the results of a dose-intense chemotherapy regimen designed to rapidly induce remissions in patients with advanced multiple myeloma (MM). Patients received VAD for 3-6 cycles depending on response kinetics. This was followed by three sequential cycles of cyclophosphamide (CTX) at 3 g/m2 every 15 days with G-CSF support. 71% of these patients had stage IIIa, 23% had renal failure. The median age was 58, median beta-2 microglobulin 4.6 and median albumin was 3.5, indicating poor prognosis. Of 35 patients, 66% achieved a complete response (CR) (SWOG). Six patients (18%) had a partial response. Fifty percent of the patients with renal failure recovered their kidney function. High-dose CTX contributed to tumor-mass reduction particularly in patients presenting with high-tumor burden. Tumor-mass reduction following three pulses of dexamethasone (4 days each) is significantly higher than with one pulse (p < 0.005). While high beta-2 microglobulin and LDH levels (p < 0.05) were associated with poor outcome, patients who responded faster to chemotherapy had a longer survival (p = 0.005). We conclude that this regimen is safe and effective. A rapid response may be useful in selecting patients who may benefit from further high dose chemotherapy and stem cell support.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biomarkers / blood
  • Biomarkers / urine
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Follow-Up Studies
  • Humans
  • L-Lactate Dehydrogenase / blood
  • L-Lactate Dehydrogenase / urine
  • Male
  • Middle Aged
  • Multiple Myeloma / complications
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / mortality*
  • Prognosis
  • Remission Induction / methods
  • Renal Insufficiency / etiology
  • Salvage Therapy
  • Time Factors
  • Treatment Outcome
  • Vincristine / administration & dosage
  • beta 2-Microglobulin / blood
  • beta 2-Microglobulin / urine

Substances

  • Biomarkers
  • beta 2-Microglobulin
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • L-Lactate Dehydrogenase

Supplementary concepts

  • VAD protocol