Introduction
Multiple myeloma is often an incurable disease.
Despite all of the new developments in myeloma
therapy worldwide, conventional-dose chemother-
apy remains the mainstay of therapy for most of our
patients. As compared to the combination of mel-
phalan and prednisolone (MP), combination
chemotherapy with the addition of anthracyclines,
nitrosourea, vincristine, or cyclophosphamide has
not led to significantly improved remission rates or
survival (1). Only 5% of myeloma patients treated
with standard-dose chemotherapy achieve true com-
plete remissions (CR) as defined by the absence on
immunofixation analysis of paraprotein in serum
and urine, and negative bone marrow aspirate and
biopsy. Partial remissions (PR) are achieved in
30–70% of patients with standard-dose chemother-
apy (2). High-dose chemotherapy with stem cell
rescue in previously untreated myeloma patients has
been found to result in an overall response rate of
about 80%, with a CR rate of 20–30% using the
strict criteria. However, the criteria for defining the
complete or partial response have been variable. The
median survival approximates 5 yr (3). However,
many individuals in developing countries, including
India, are unable to afford transplant costs. We,
therefore, studied the impact of a less expensive reg-
imen that used non-cross-resistant regimes of VAD
(vincristine, adriamycin, dexamethasone) followed
by VMCP (vincristine, melphalan, cyclophospha-
mide, prednisolone).
Materials and Methods
Case records of newly diagnosed and previously
untreated patients with multiple myeloma who had
received sequential chemotherapy with VAD fol-
lowed by VMCP were analyzed. The patients had
been given the two study regimens (VAD and
VMCP) as per the following schedule:
VAD Followed by VMCP
An Alternative Regimen for Multiple Myeloma
Jyoti Wadhwa, Lalit Kumar, and Vinod Kochupillai
Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
Abstract
In patients with multiple myeloma, a good complete response rate and disease-free survival may be
achieved with sequential chemotherapy using VAD and VMCP, which is an alternative effective and less
expensive treatment regimen. This regimen thus assumes particular significance in developing nations like
India, where the majority of patients with myeloma cannot afford the cost of high-dose chemotherapy with
stem cell rescue.
Key Words: Multiple myeloma; sequential; chemotherapy; response rate; survival.
105
Original Article
Received 01/07/02; Revised 02/17/02; Accepted 02/20/02.
Address Correspondence to Dr. Jyoti Wadhwa, M.D., D.M.,
Department of Medical Oncology, Institute Rotary Cancer
Hospital, All India Institute of Medical Sciences, New Delhi
110029, India. E-mail: jyotiwadhwa@hotmail.com
Medical Oncology, vol. 19, no. 2, 105–108, 2002
© Copyright 2002 by Humana Press Inc.
All rights of any nature whatsoever reserved.
1357-0560/02/19:105–108/$11.00