The VAD-DCEP sequence is an effective pre-transplant therapy in untreated multiple myeloma

Alessandro Corso, Luciana Barbarano, Patrizia Zappasodi, Roberto Cairoli, Emilio Paolo Alessandrino, Silvia Mangiacavalli, Daris Ferrari, Sergio Fava, Mario Fiumanò, Guido Frigerio, Luciano Isa, Annalisa Luraschi, Catherine Klersy, Alberto De Paoli, Claudio Vergani, Luciano Banfi, Daniele Perego, Gianni Ucci, Graziella Pinotti, Maria SavarèLilj Uziel, Alessandro Vismara, Enrica Morra, Mario Lazzarino

Research output: Contribution to journalArticle

Abstract

Background and Objectives. Standard treatment for patients with multiple myeloma is debulking chemotherapy with non-alkylating agents followed by a regimen to mobilize peripheral blood stem cells (PBSC) and the transplantation of the mobilized, autologous PBSC. The aim of this study was to evaluate the efficacy of a new regimen and compare it with that of a previous regimen. Design and Methods. In a large cohort of 106 patients (group I) we administered a new pre-transplant program which includes 2 courses of pulsed-VAD (vincristine, adriamycin, dexamethasone) followed by 2 courses of DCEP (dexamethasone, cyclophosphamide, etoposide and cis-platinum). We compared the efficacy of this new VAD-DCEP sequence, in terms of mobilizing capacity, toxicity and anti-myeloma activity in comparison with that of the previous VAD-high-dose cyclophosphamide program (group II, 40 patients). Results. In group I 81/106 (76.4%) patients yielded ≥ 4×106/kg CD34+ cells, as did 30/40 (75%) in group II but with a significantly higher toxicity in this latter group. In detail, 9 patients in group I (8.5%) had WHO grade III neutropenia versus 35 in group II (87.5%), 5 patients of group I (4.7%) had grade III thrombocytopenia versus 12 patients in group II (30%), and 8 patients in group I (7.5%) experienced an infections fever versus 9 patients in group II (22.5%). Therefore, nearly all patients in group II had to be admitted to hospital (39/40, 97.5%). There was a higher percentage of responses (CR+VGPR+PR) in group I than in group II: 73% versus 50% (p=0.02). Interpretation and Conclusions. the VAD-DCEP sequence has an adequate mobilizing capacity, without significant toxicity, and a good anti-myeloma activity, and therefore represents a safe and effective therapeutic approach for multiple myeloma patients at the onset of their disease.

Original languageEnglish
Pages (from-to)1124-1127
Number of pages4
JournalHaematologica
Volume89
Issue number9
Publication statusPublished - Sep 2004

Keywords

  • CD34 cells
  • DCEP
  • HDCTX
  • High-dose therapy
  • Mobilization

ASJC Scopus subject areas

  • Hematology

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    Corso, A., Barbarano, L., Zappasodi, P., Cairoli, R., Alessandrino, E. P., Mangiacavalli, S., Ferrari, D., Fava, S., Fiumanò, M., Frigerio, G., Isa, L., Luraschi, A., Klersy, C., De Paoli, A., Vergani, C., Banfi, L., Perego, D., Ucci, G., Pinotti, G., ... Lazzarino, M. (2004). The VAD-DCEP sequence is an effective pre-transplant therapy in untreated multiple myeloma. Haematologica, 89(9), 1124-1127.