efficacy of VAD 'vincristine, adriamisine,dexamethazone' and high dose therapy- otolog stem cell transplantation in multiple myeloma

In this retrospective study, we aimed to evaluate the response rates of first line VAD chemotherapy in newly diagnosed MM patients. The prognostic impact of VAD response on overall survival and its relationship with other prognostic markers were assessed. The medical charts of 133 MM patients followed at Gazi University Department of Hematology and/or Stem Cell Transplantation Unit between 02,09,99 and 01,12,09 were retrospectively reviewed. Seven patients who could not be evaluated for VAD response were excluded the study. Basic characteristics of 126 patients including age, gender, type and stage of the disease, risk stratification and deletion 13q status were noted. Hemoglobin, leukocyte and platelet counts, levels of creatinine, calcium, albumin, globulin, lactate dehydrogenase, erythrocyte sedimentation rate, C reactive protein, ß2 microglobulin, immunoglobulins and free light chains, proteinuria, creatinine clirence, bone marrow plasma cell percentage, amyloidosis, reticulin fibrosis and lytic lesions were recorded. Staging and prognostic assessment were based on the data collected at diagnosis. EBMT criteria were used to evaluate VAD response. Overall survival and progression free survival after VAD were also analysed. Overall response was achieved in 74 (59%) patients. Complete and partial response rates were 15% and 32% respectively. Progression free survival was found to be better in VAD responders, while overall survival was not different between responders and non-responders. Response to VAD was worse in patients with deletion 13q, lambda monoclonality and advanced age. High dose chemotherapy with melphalan 200 mg/m2 resulted in better overall survival and progression free survival.