Investigational New Drugs

, Volume 29, Issue 1, pp 175–181 | Cite as

Initial cytoreductive treatment with thalidomide plus bolus vincristine/doxorubicin and reduced dexamethasone followed by autologous stem cell transplantation for multiple myeloma

  • Jae-Cheol Jo
  • Byung Woog Kang
  • Sun Jin Sym
  • Sung Sook Lee
  • Geundoo Jang
  • Shin Kim
  • Dae Ho Lee
  • Sang-We Kim
  • Jung Shin Lee
  • Cheolwon Suh
PHASE II STUDIES
  • 78 Downloads

Summary

Background High-dose chemotherapy supported by autologous stem cell transplantation (ASCT) after combined chemotherapy with infusional vincristine/doxorubicin plus dexamethasone is effective in multiple myeloma (MM). Outpatient treatment with bolus vincristine/doxorubicin infusion plus dexamethasone is convenient and has acceptable efficacy and toxicity for MM. Thalidomide has recently been shown to have significant antimyeloma activity. We assessed the efficacy and toxicity of the combination of bolus vincristine/doxorubicin and reduced dose dexamethasone with thalidomide (T-bVAd), administered on an outpatient basis, in untreated MM. Patients and methods Twenty-six patients prospectively received T-bVAd, consisting of intravenous (i.v.) vincristine 0.4 mg plus doxorubicin 9 mg/m2, administered as a single bolus on days 1 to 4, dexamethasone 20 mg per os daily for 4 days, and thalidomide 200 mg/day at bedtime. Response assessment was conducted after each 4-week treatment cycle. Patients who achieved response were allowed to proceed to high-dose chemotherapy with ASCT. Results On an intention-to-treat basis, 23 of the 26 patients (88%) responded to treatment, with 16 (61%) achieving complete response (CR), 2 (8%) very good partial response (VGPR) and 5 (19%) partial response. Only three patients (12%) were rated as non-responders. Grade 3 and 4 hematologic toxicities consisted of neutropenia (13%), febrile neutropenia (6%), and thrombocytopenia (4%), without significant nonhematologic events. Of the 23 patients who showed response, 7 proceeded to single ASCT and 9 to tandem ASCT. With median follow-up time of 15.3 months (range, 9–25 months), median event free survival (EFS) and overall survival (OS) have not been reached yet, and OS and EFS rates for patients who achieved complete response after T-bVAd regimen were significantly higher than patients not. Conclusions Induction therapy with T-bVAd, administered as an outpatient regimen, was efficient and relatively well tolerated in the treatment of MM.

Keywords

Induction therapy Autologous stem cell transplantation Multiple myeloma Modified schedule 

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jae-Cheol Jo
    • 1
  • Byung Woog Kang
    • 1
  • Sun Jin Sym
    • 2
  • Sung Sook Lee
    • 3
  • Geundoo Jang
    • 4
  • Shin Kim
    • 1
  • Dae Ho Lee
    • 1
  • Sang-We Kim
    • 1
  • Jung Shin Lee
    • 1
  • Cheolwon Suh
    • 1
    • 5
  1. 1.Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  2. 2.Department of OncologyGachon University Gil HospitalIncheonKorea
  3. 3.Department of Oncology, Severance HospitalYonsei University College of MedicineSeoulKorea
  4. 4.Department of OncologyHallym University Chunchon Sacred Heart HospitalChunchonKorea
  5. 5.Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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