Outpatient treatment of multiple myeloma with a combination of vincristine, Adriamycin and dexamethasone

Patients with relapsed multiple myeloma (MM) have been shown to respond to a combination therapy consisting of vincristine, Adriamycin (doxorubicin) a nd high-dose dexamethasone (VAD). Because of the low hematological toxicity of the VAD regimen, this combination is frequently chosen for tumor reduct ion prior to high-dose therapy and blood stem cell transplantation. This st udy was designed to examine the efficacy and complications of outpatient VA D treatment. Over a period of 6 years, 103 outpatients with MM were treated with VAD chemotherapy administered by microprocessor-controlled infusion p umps via intravenous polyurethane catheters equipped with a safety valve. R esponse to treatment, treatment-associated complications and infections wer e documented and analyzed. In 85 of the 103 patients, tumor reduction by mo re than 25% was found. In 8 patients an occlusion occurred as a result of k inking of the central venous catheter in the subcutaneous segment. In two t reatment cycles the infusions had to be stopped because of irreversible cat heter occlusion. Twenty patients were hospitalized because of complications , which were infectious in 12 and noninfectious in 8. Severe infectious com plications ( greater than or equal to WHO grade III) occurred in 5.6% of th e treatment cycles. Thus, continuous infusion of VAD over 96 h can be perfo rmed on an outpatient basis with a low complication rate.