Vad regimen as front line therapy in multiple myeloma, fouad abu taleb

الملخص EN

Purpose : we have planned this study to evaluate the response and toxicity of VAD regimen as a front line therapy in 35 newly diagnosed symptomatic myeloma patients.

Methods And Materials : All patients were subjected to the following : complete history, clinical examination, routine laboratory investigations, radiological investigations, and specific investigations including plasma viscosity determination, immunoglobulin and cryoglobulin quantita-tion, immunoelectrophoresis and immuno-fixation.

All patients were treated with VAD regimen which consisted of vincristine 0.4 mg / day and doxorubicin 9 mg / m2 administered by continuous infusion for 4 days with oral dexa-methasone 40 mg / day for days 1-4, 9-12 and 17-20 for the first cycle only to be repeated every 28 days for 4 cycles then reevaluation to determine the response to therapy based on the degree of reduction of M-component.

Results : our results showed that the frequency of Ig isotypes was IgG (57.1 %), IgA (37.1 %) and light chain disease (5.7 %).

For light chain type: Kappa (54.3%).

Lambda (31.4 %), Kappa and free Kappa (2.9 %).

Lambda and free Lambda (5.6 %) free Kappa and free Lambda each 2.9 %.

All studied parameters showed significant changes after 4 cycles of VAD regimen including elevation of hemoglobin level, platelet count and S.

albumin and reduction of ESR level, S.

creatinine, S.

calcium, CRP, LDH and M-band.

Monoclonal immunoglobulin was reduced with elevation of other normal immunoglobulins.

The overall response was 85.7 % (30 / 35) with CR2 in 5 patients (14.3 %) and PR2 in 25 patients (71.4 %).

The response was rapid occurring after 2 cycles of VAD.

Median response duration was 20 months.

The estimated median survival for all patients was 42 months, with 79 % 2 years overall survival.

Toxicity was acceptable ; only side effects due to steroid were noticed.

Conclusion : so, we can conclude that the high response rate and lack of toxicity of VAD regimen as a primary therapy for multiple myeloma patients are promising and warrants further evaluation and modification although other strategies will be necessary to prolong the duration of response.