Multiple myeloma: VMCP/VBAP alternating combination chemotherapy is not superior to melphalan and prednisone even in high-risk patients.

Abstract

The efficacy of alternating vincristine, melphalan (M), cyclophosphamide, prednisone/vincristine, carmustine, doxorubicin, and prednisone (VMCP/VBAP) polychemotherapy was compared with the M and prednisone (MP) regimen as induction treatment in multiple myeloma (MM). Three hundred four MM patients entered this study between March 1983 and July 1986; the analysis was performed in December 1989. The treatment groups did not show significant differences with respect to major prognostic factors. Median overall survival was 33.8 months. In the VMCP/VBAP and MP arms, after 12 induction chemotherapy cycles, 59.0% and 47.3% (P less than .068) of the patients achieved an M component reduction greater than 50%. No significant difference was observed in the two treatment arms in terms of remission duration (21.3 v 19.6 months, P less than .66) and survival (31.6 v 37.0 months, P less than .28). Patients younger than 65 years did not show any advantage from the alternating polychemotherapy. At diagnosis, the plasma cell labeling index (LI) and serum beta-2 microglobulin (beta 2-m) were evaluated in 173 and 183 patients, respectively. A significantly reduced survival was observed for patients with LI greater than or equal to 2% (16.4 months) or beta 2-m greater than or equal to 6 mg/L (20.4 months). Even in these poor-risk subgroups, VMCP/VBAP was not superior to MP.

• Authors: M Boccadoro, F Marmont, M Tribalto, G Avvisati, A Andriani, T Barbui, M Cantonetti, M Carotenuto, B Comotti, F Dammacco
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 9 Issue 3 Pg. 444-8 (Mar 1991) ISSN: 0732-183X [Print] United States
• PMID: 1999714 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• beta 2-Microglobulin
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Melphalan
• Carmustine
• Prednisone

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carmustine (administration & dosage)
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Drug Administration Schedule
• Female
• Humans
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Multiple Myeloma (drug therapy, mortality, pathology)
• Prednisone (administration & dosage)
• Prognosis
• Vincristine (administration & dosage)
• beta 2-Microglobulin (isolation & purification)