Vincristine, doxorubicin, and dexamethasone or thalidomide plus dexamethasone for newly diagnosed patients with multiple myeloma?

Multiple myeloma (MM) is a malignant plasma cell tumor that is distributed at multiple sites within the bone marrow compartments. High-dose dexamethasone regimens [including vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy] induce rapid responses, and have resulted in improved survival for many patients when followed by intensive therapy with autologous stem cell support early in the disease course. However, VAD have several disadvantages including the need for an intravenous indwelling catheter, which predisposes patients to catheter-related sepsis and thrombosis; most of the activity of VAD was from high-dose dexamethasone component. We enrolled all patients who fulfilled entire criteria for MM during the period between January 1997 and December 2005. The present study is a descriptive, retrospective, longitudinal, and observational one. The frequency of response (CR, VGPR/NCR, and PR) in the group of thalidomide and dexamethasone was 84.3% (CR 18.75% VGPR/NCR 18.75%, and PR 46.8%) being higher than VAD, 55% (CR 16%, VGPR/NCR 5%, and PR 34%). P = 0.0005. In summary, we conclude Thal/dex is an effective therapy in newly diagnosed MM inducing objective responses in over 84.3%.