Cyclophosphamide, adriamycin and dexamethasone (CAD) is a highly effectivetherapy for patients with advanced multiple myeloma

Background: Patients with advanced multiple myeloma (stage III or progressi ve myeloma) received the CAD protocol every three weeks: cyclophosphamide 2 00 mg/m(2) i.v./orally days 1-4, adriamycin 30 mg/m(2) i.v. on day 1 and de xamethasone 40 mg p.o. days 1-4. Patients and methods: Forty-six patients with a median age of sixty years ( range 34-84 years) were enrolled. According to Durie-Salmon 44 patients wer e in stage III, 2 in stage II; 6 patients had renal insufficiency (stage B) . Twenty-three patients were pre-treated at least with melphalane/prednison e. Results: Remission rates were as follows: complete remission 4%, partial re mission 70%, minimal change 11%, no change 11%, progressive disease 4%. Aft er an observation time of 14 months the median progression free interval fo r 33 patients not treated with subsequent high-dose chemotherapy with stem- cell support was more than 14 months. Overall, treatment was well tolerated . After 209 cycles given febrile neutropenia occurred in 11% of cycles incl uding one fatal outcome. Neutropenia or thrombocytopenia grade 3-4 WHO was recorded in 18% and 6% of the cycles, respectively. Conclusions: This study shows that CAD is an effective regimen with an over all remission rate of 74%. The CAD protocol should be further evaluated in prospective trials.