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VAD chemotherapy for refractory multiple myeloma

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.