Treatment of plasma cell leukemia with vincristine, liposomal doxorubicin and dexamethasone

Primary plasma cell (PCL) leukemia is a rare lymphoproliferative disorder c haracterized by a malignant proliferation of plasma cells in the bone marro w and peripheral blood. Survival with standard therapy using melphalan is v ery poor. Doxorubicin encapsulated with liposomes has less cardiotoxicity, is at least as efficient and has fewer side effects than conventional doxor ubicin. Two female patients (69 and 54 yr old) with primary PCL are describ ed in this study. They both received a modified form of VAD (vincristine, d oxorubicin and dexamethasone), a regimen which includes liposomal doxorubic in (40 mg/m(2) for I d), vincristine (2 mg for I d) and dexamethasone 40 mg per os on days 1-4, 9-12 and 17-20. A disease evaluation of the first patient after six courses of the modified WAD regimen showed no plasma cells in the peripheral blood, a decrease in the serum M protein level and a plasma cell infiltration in the bone marrow of less than 5%. The patient died from a cardiac episode 24 months post-di agnosis, while she was in complete hematological remission. The second pati ent also exhibited good tolerance to liposomal doxorubicin with no side eff ects, achieved complete haematological remission and remains in good condit ion 7 months after the last VAD administration. These results suggest that this modified form of VAD regimen also seems to work in PCL and is well tol erated with no side effects.