VAD or VMBCP in multiple myeloma refractory to or relapsing after cyclophosphamide–prednisone therapy (protocol MY 85)

263 patients (median age 65±10 years) with multiple myeloma were treated with cyclophosphamide– prednisone. Out of this cohort, 103 patients had progressive disease and were randomly assigned to either VAD (vincristine, doxorubicin, dexamethasone; 50 cases) or VMBCP (vincristine, BCNU, cyclophosphamide, melphalan and prednisone; 53 cases). There were no statistical differences between the two groups with the respect to clinical, biological and radiological parameters. There was no difference in survival between the VAD and VMBCP groups. The 4 months response rate was similar in the two groups (50% VAD, 56% VMBCP). With multivariate analysis for survival (Cox model), two factors had a statistically significant impact: Karnofsky index (>60) and albuminaemia (<34 g/l). With both Karnofsky index > 60 and albuminaemia 34 g/l, the median survival was 29 months v 2 months with a Karnofsky index 60 and albuminaemia < 34 g/l (P < 0.05). In conclusion, VAD or VMBCP had similar activity for salvage treatment in MM refractory or relapsing to first-line treatment with cyclophosphamide–prednisone.     

High-dose cytosine arabinoside intensification for acute nonlymphocytic leukemia in patients over 56 years of age

Summary One hundred and nine consecutive patients with de novo acute nonlymphocytic leukemia aged over 56 years were admitted with the intention of administering high-dose cytosine arabinoside (HD Ara-C) intensification. After remission induction, the patients were consolidated with a course of daunorubicin (30 mg/m²day, days 1–3) and Ara-C (100 mg/m²day, days 1–7), followed by the intensification (Ara-C, 2 g/m²12 h, days 1–4). The planned induction course was not started in 13 patients because of cardiac failure or unsatisfactory general status. Remission was achieved in 55% (53/96) of the patients. Twenty-seven patients (28%) had refractory disease, seven died early during induction therapy, five died of hemorrhage and three of infection during the hypoplasia that followed induction treatment. Thirty-nine patients started consolidation and 32 had the planned intensification. In these last patients the 3-year leukemia-free survival (LFS) probability was 29% (SE, 8%). No patient died as a consequence of intensification. The relapse rate of the intensified patients did not differ from the relapse rate of those patients who did not receive the planned intensification (p=0.12). The only pretreatment variables significantly associated with a better LFS were younger age (p=0.02) and a low WBC at diagnosis (p=0.04). For the whole patient group, the 3-year survival probability was 15% (SE, 4%).This study shows that elderly patients can tolerate HD Ara-C. The patients completing consolidation-intensification have a currently acceptable LFS. To what extent HD Ara-C contributed to the length of the remissions remains unclear.