Administration of a modified chemotherapeutic regimen containing vincristine, liposomal doxorubicin and dexamethasone to multiple myeloma patients: preliminary data

For elderly patients with multiple myeloma (MM), conventional melphalan and prednisone (MP) therapy has been the treatment of choice; the vincristine, doxorubicin and dexamethasone (VAD) regimen is preferred for younger patie nts who also receive high-dose melphalan in combination with autologous or allogeneic bone marrow transplantation (BMT). Although survival time is sim ilar in both the MP and VAD regimens, the continuous infusion of doxorubici n which the latter treatment entails constitutes a disadvantage along with the 4-day hospitalization required. Doxorubicin also induces cardiotoxicity , particularly in the elderly. A modified form of VAD therapy includes lipo somal doxorubicin (Caelyx(R)) (40 mg/kg for 1 d), oncovin (2 mg for 1 d) an d dexamethasone 40 mg for 4 d per os. Doxorubicin encapsulated with liposom es has less cardiotoxicity, is more efficient and has fewer side effects th an conventional doxorubicin, and it can be administered on an outpatient ba sis: dexamethasone can be given orally and vincristine in bolus infusion. I n order to estimate its efficacy and tolerability, we administered this reg imen to 12 patients (first-line treatment in 6 patients, salvage therapy in 6 patients). All patients exhibited good tolerance to liposomal doxorubici n with no severe side effects. Eight patients achieved complete hematologic al remission and three partial response. One patient died before completing the treatment. In conclusion, compared to other therapies, this modified V AD regimen containing liposomal doxorubicin can be more easily administered to MM patients, without severe side effects and with increased full remiss ion rates, almost similar to those with the conventional VAD treatment.