This article reports the efficacy of two salvage programs for primary resistant and relapsed
multiple myeloma. Employing high dose
dexamethasone alone or combined with continuous infusions of
vincristine and
adriamycin (VAD) in 83 patients, 1/3 achieved a greater than or equal to 75%
tumor cytoreduction. The highest response rate of 65% was observed among previously responding patients receiving VAD compared to approximately 1/4 among those receiving VAD for primary resistant disease or
dexamethasone alone regardless of prior response status.
Tumor halving times were short with values of 0.5 months for VAD and 1.3 months for
dexamethasone alone. The single most important pretreatment variable associated with failure to achieve remission was a low
RNA content of myeloma plasma cells in the bone marrow. The second program evaluated high dose
melphalan with or without autologous
bone marrow transplantation in 23 patients resistant to VAD
salvage treatment. Ten of 23 patients responded for at least 2 months, and 4 others had a comparable anti-
tumor effect but died between 4-6 weeks from disseminated
infection. Unlike the
VAD regimen, responses occurred regardless of prior response or plasma cell
RNA content, and
tumor halving times were extremely short with a median of 0.3 months. With autologous bone marrow support, the higher
melphalan dose (140 vs. 100 mg/m2) could be more safely administered to an older patient population (median of 63 vs. 44 years) with 1 of 7 vs 6 of 16
drug-related deaths in the absence of marrow support.(ABSTRACT TRUNCATED AT 250 WORDS)