With the aim of developing an effective
therapy for heavily pretreated refractory MM outpatients, we evaluated the
OPPEBVCAD regimen, a
Hodgkin's disease-derived protocol that includes many drugs effective in MM administered in a sequential schedule. Twenty-two pts aged 42-72 years, with symptomatic highly-pretreated refractory (18 cases), or primary resistant MM (four cases. including two pts with
plasma cell leukemia-PCL) received this
therapy every 28 days (2-4 cycles, followed by a maintenance program). Therapeutic response (Chronic
Leukemia-Myeloma Task Force criteria) and performance status (PS) and
pain (W.H.O.) were evaluated. All of the pts were evaluable for response. There were 9 (40%) objective responses (OR: stabilization of blood counts and bone lesions, serum
calcium normalization, 50% or more reduction in the concentration of serum monoclonal component (MC), 90% reduction in Bence-Jones
proteinuria), 8 (36%) partial responses (PR: 25-50% reduction in serum MC), 1 no response or stable disease (NR), and 4 (18%) cases of progressive disease (PD). OR plus PR were 77%. Of the 4 primary resistant
tumors (2 PCL and 2 MM), 2 achieved PR, 1 OR (a PCL case) and 1 progressed. Median survival was 15 months for responding pts (OR plus PR) and 4.5 months for non-responders (NR plus PD). PS and
pain improved in 15 pts and did not change in 9. The most frequent side effects were
cytopenias, with one
drug related infective death. The
OPPEBVCAD regimen proved to be an effective
therapy for refractory relapsing or primary resistant MM: in responders (two-thirds of the pts), survival was prolonged by about 10 months. Its efficacy in
anthracycline-treated pts, as well as the feasibility of using it on an outpatient basis without any continuous
drug infusions, make this regimen a promising third line
salvage therapy.