Dexamethasone, cyclophosphamide, idarubicin and etoposide (DC‐IE): a novel, intensive induction chemotherapy regimen for patients with high‐risk multiple myeloma

Abstract

Summary.We evaluated toxicities and responses to a novel, dose intensive and time sequenced, chemotherapy programme (DC-IE) in 45 patients with high-risk myeloma. DC-IE consisted of: dexamethasone (days 1-4); cyclophosphamide (day 5); idarubicin and etoposide (days 8-10). Complete response (CR) was achieved in four patients, six patients achieved near complete responses (nCR) and 21 patients achieved a partial remission (PR). Overall response rate was 76% (CI 56-94%) for newly diagnosed patients (n ¼ 21) and 62% (CI 36-81%) for relapsed/refractory patients (n ¼ 24). Toxicities were limited to myelosupression; two patients died of sepsis during neutropenia (4%). DC-IE is active and tolerable for high-risk multiple myeloma, including patients with relapsed or refractory disease to anthracycline containing regimens.

Criteria for Evaluating Disease Response and Progression in Patients With Multiple Myeloma Treated by High‐dose Therapy and Haemopoietic Stem Cell Transplantation

“…There are also currently no generally accepted criteria for the definition of disease progression or relapse and papers reporting the results of different treatment regimens do not always specify the criteria used to define progression ( MacLennan et al , 1992 ; Ballester et al , 1997 ; Barlogie et al , 1997 ). Bergsagel et al (1979 ) defined progression as a progressive increase in serum paraprotein of at least 10 g/l or a 100% increase in urinary light chain excretion.…”

“…With the introduction of new regimens such as VAD (vincristine, adriamycin and dexamethasone) and high‐dose melphalan (140 mg/m 2 ) without stem cell support, measurable paraprotein disappeared in a significant proportion of patients and criteria for complete remission were formulated ( Selby et al , 1987 ; Gore et al , 1989 ; Samson et al , 1989 ). As the use of high‐dose therapy has increased there has been a consequent increase in the number of patients entering CR, and other groups have published their own definitions of CR; as shown in Table IV ( Gahrton et al , 1991 ; Anderson et al , 1993 ; Dimopoulos et al , 1993 ; Bjorkstrand et al 1995b ; Attal et al , 1996 ; Vesole et al , 1996 ; Barlogie et al , 1997 ; Ballester et al , 1997 ; Joshua et al , 1997 ; Schiller et al , 1998 ). All groups agreed that there should be no detectable paraprotein in serum or urine together with a normal number of plasma cells in the marrow (i.e.…”

An update on molecular biology and drug resistance mechanisms of multiple myeloma

“…In refractory and relapsing myeloma patients, vincristine, doxorubicine and dexamethasone (VAD), cyclophosphamide and etoposide (Cy-E) and regimens consisting of etoposide, cisplatin, cytarabine and dexamethasone were used (Alexanian et al, 1986;Ballester et al, 1997). However, vincristine is no longer commonly used as a part of the VAD regimen, which was shown to be inferior to bortezomib, doxorubicin and dexamethasone (Brian and Durie, 2015).…”

Cyclophosphamide, etoposide, vincristine, adriamycin, and dexamethasone (CEVAD) regimen in refractory multiple myeloma: An international oncology study group (IOSG) phase II protocol

“…(DC-IE) as MM salvage therapy, have given favorable results[31,32]. Dimopoulous et al have previously documented the efficacy of a combination of cyclophosphamide, etoposide, and GM-CSF in VADresistant MM, reporting a 42% PR rate in 52 patients…”