Haematologica 2003 - Supplements

Methods. We investigated the VECD protocol, a VAD-based
regimen using bolus injections of vincristine 1.5 mg day 1 and
epirubicin 20 mg/m2 days 2 and 3 with 1 h infusions of
cyclophosphamide 200 mg/m2 days 1-3 and oral dexamethasone
20 mg/m2 days 1-5 as induction and salvage treatment in multiple
myeloma. The cycles were repeated every 3 weeks.
Results. 22 patients were treated on study and received median 3
cycles (range 2-8). No patient achieved a CR. The overall rate of
PR was 15/36 (42%). Patients achieved maximal response after a
median of 4 (range 3-6) courses. PR rates were 40% (3/8) in
patients with primary refractory disease, 50% (7/14) in patients
with secondary refractory disease, and 50% (7/14) in patients
receiving 2nd or subsequent relapse therapy. Two patients died
during their initial cycle of therapy from rapidly progressive
disease and sepsis. The overall median survival was 24 weeks
with a 1-year survival of 33.3% {95% confidence interval of 20-
46%}. Myelosuppression was the most frequent adverse event
with NCI grade 2 neutropenia and/or thrombocytopenia in 15%
of first cycles, grade 3 in 20%, and grade 4 in 65%.Two-thirds of
patients had at least one episode of grade 3 or 4 sepsis. In 15% of
septic episodes positive blood cultures were obtained. Overt
cardiotoxicity was seen in two patients.
Conclusion. VECD appears to be an effective regimen for salvage
therapy in multiple myeloma. Based on the limited number of
patients treated the results are comparable to those reported for
VAD, with the advantage that the infusional application of
vincristine and the anthracycline is omitted. E-mail:
mbadea@craiova.pcnet.ro
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Chemotherapeutical regimen Ifosfamide + Epirubicine
(IE) – an effective salvage and mobilisation regimen for
multiple myeloma patients, who insufficiently
responded to induction therapy VAD or VID. One centre
experience
E.Gregora(1), M.Jankovska(1), K.Kubackova(2),
M.Holikova(3), M.Greplova(4), T.Kozak(1)
(1)Department of Clinical Hematology, University Hospital
Kralovske Vinohrady, Prague (2)Department of Oncology, Faculty
Hospital Motol, Prague (3)Department of Oncology,Hospital
Liberec (4)Department of Blood Transfusion,University Hospital
Kralovske Vinohrady, Prague
Background: Chemotherapeutical regimen IE has been used as an
induction and mobilisation therapy for newly diagnosed multiple
myeloma patients. Sufficient antimyeloma effect and
mobilisation property of this regimen had been already proved.
We decided to verify its effectiveness in multiple myeloma
patients, who insufficiently responded to induction therapy VAD
or VID.
Patients and methods: From 1/01 to 1/03 10 patients with
multiple myeloma received IE therapy – their median age was 55
years (range 50-65 years); clinical stage I – 1x, II – 7x, III – 2x;
type of paraprotein IgA – 2x, IgG 7x, light chains – 1x.
Results: 9 patients underwent 3 courses and 1 patient 4 courses of
IE therapy. Therapeutical response was noticed in 8 cases (CR
1x, PR 7x) and none response in 2 cases. Haematological toxicity
grade III or IV (according to WHO classification) appeared in 4
cases. Non-haematological toxicity of this grade did not appear.
Regimen IE + G-CSF (10 ug/kg/day) was used for mobilisation
of peripheral blood stem cells during 2nd course of therapy in 3
patients, during 3rd course of therapy in 6 patients and during 4th
course of therapy in 1 patient. Yield was sufficient in all cases
except one.
Medial follow up was 17 months (10-24 months). All patients
received further therapy (2xHD Mel +HSCT 7x, 1xHD Mel +
HSCT 2x, thalidomide + dexamethasone 1x). Recently 8 patients
are in remission (2xCR, 6xPR), and 1 patient has stabile disease.
One patient died early after transplantation.
Conclusion: Chemotherapeutical regimen IE has satisfactory
antimyeloma effect and good mobilisation property for multiple
myeloma patients, who insufficiently responded to induction
therapy VAD or VID.
240
Retrospective analysis of response to vincristinedoxorubicin-dexamethasone
(VAD) chemotherapy
before autologous transplantation in multiple myeloma
Ross, D.M., To, L.B. and Horvath, N.
Division of Haematology, Institute of Medical & Veterinary Science
and Department of Clinical Haematology and Bone Marrow
Transplantation, Royal Adelaide Hospital, Adelaide, SA 5000,
Australia.
Background: The combination VAD (vincristine, doxorubicin
and either methylprednisolone or dexamethasone in equivalent
doses) is used in our centre as the initial chemotherapy in
myeloma patients planned to proceed to high dose therapy and
autologous haematopoietic stem cell transplantation. We
retrospectively analysed the monoclonal protein responses and
survival data in 62 patients treated in this way. The aim was to
assess the relative response to components of the pre-transplant
chemotherapy and its relation to the overall disease response.
Methods: Clinical and laboratory data were reviewed for the 62
patients. Skeletal imaging results were not available and so
response rates are referred to as unconfirmed. Defined events for
survival analysis were rising paraprotein, commencement of
salvage regimen or death. The median age of patients was 55
years. Only two patients had prior chemotherapy, while 29 had
prior or concomitant local radiotherapy.
Results: The average reduction in paraprotein after the first cycle
of VAD was 37% in serum and 69% in urine. After the third
cycle, the reduction was 59% and 89% respectively. The
unconfirmed complete remission rate (uCR) was 6% and for
partial remission (uPR) 60%. Following cyclophosphamide
mobilisation the uCR rate rose to 11%, while the uPR rate was
unchanged.
Greater than 50% reduction in monoclonal protein after the first
cycle of VAD was observed in 39.6% of patients. This group had
a significantly better event-free survival (EFS at 3 years 53.6%
vs. 12.0%; p=0.05) than those with