Background : Multiple myeloma(MM) remains as an incurable malignant disorder as a
result of resistance to chemotherapy. With standard dose of alkylating agents such as
melphalan and prednisone (MP) or alkylating agent combinations with or without
doxorubicin, responses are achieved in approximately 50% of patients, and relapse
typically ensues after a median of 18 months. Therefore, salvage therapy becomes
important for half of the patients with newly diagnosed MM who fail to achieve
remission(primary refractory) and for responders who have a relapse despite
myelosuppressive doses of chemotherapy(secondary refractory). The VAD regimen,
comprising vincristine and doxorubicin given by continuous infusion along with high
doses of dexamethasone has achieved a marked tumor reduction in about one half of
patients. So we investigated the efficacy of VAD regimen for patients with refractory
multiple myeloma.
Methods: Twenty-two patients with refractory multiple myeloma were treated
according to the VAD protocols proposed by Barlogie et al.
Results: Of the 21 evaluable patients who completed at least one course of therapy, 9
had a complete response(43%). The response rates were 23% for primary refractory
disease patients and 75% for those with secondary refractory disease(P<0.05). The
median duration of response was 3 months(2∼18months) and the median survival for all
22 patients was 5 months(2∼21months+). Peripheral neuropathy was documented in 10
patients(45%). Bacterial infection was observed in 4 patients(1 spontaneous bacterial
peritonitis, 1 pneumonia, 1 sepsis, 1 bacteremia), of whom 2 patients died. Three patients
had mild Herpes zoster infection. Leukopenia and thrombocytopenia were observed in 8
and 2 patients, respectively.
Conclusion : These findings indicate that VAD regimen is effective for the refractory
multiple myeloma, especially for the secondary refractory multiple myeloma, but the
treatment related toxicities were serious.

Keywords: Multiple myeloma, VAD chemotherapy, Vincristine, Doxorubicin, Dexamethasone