CancerConsultants.com
Thalidomide Induction Superior to Vincristine-Doxorubicin-
Dexamethasone for Multiple Myeloma
Researchers from Italy have reported that thalidomide and dexamethasone
results in a higher response rate than vincristine-doxorubicin-dexamethasone
(VAD) for induction therapy of newly diagnosed multiple myeloma. The details of
this retrospective comparison appeared in Blood .
Therapy for multiple myeloma is rapidly evolving with the introduction of several
new agents such as Doxil® (lipsomal doxorubicin), Thalomid® (thalidomide),
Velcade® (bortezomib) and the thalidomide derivative Revlimid® (lenalidomibe).
These agents have been evaluated in patients with relapsed and refractory
disease and are now being evaluated in induction regimens. One treatment
strategy that has been extensively evaluated in patients 65 years of age or
younger is induction therapy followed by one or two high-dose treatments with
autologous stem cell support. Most of the randomized trials involving high-dose
therapy have utilized a VAD induction regimen followed by the collection of
autologous peripheral blood stem cells. The choice of VAD over melphalan
containing regimens is due to the relative lack of stem cell damage by VAD
allowing for the collection of enough stem cells for two transplants. Thus, newer
induction regimens should not be myeloablative and interfere with stem cell
collection.
Italian researchers have performed two consecutive studies involving remission
induction followed by autologous stem cell transplantation between 1996 and
2004. The first study utilized a VAD induction regimen and the second an orally
administered thalidomide-dexamethasone induction. This was a consecutive
series of 100 patients each. Patients were apparently well matched by age,
clinical stage of myeloma and serum beta 2 microglobulin. The following table
summarizes the main findings of this comparative analysis:
Table 1: Comaparative analysis of thalidomide-dexamethasone regimen to VAD
regimen
Thalidomide-Dexamethasone
VAD
Number of Patients
100
100
Median Age
54 years
54 years
Complete Remission
10%
8%
Near CR
3%
5%

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Very Good PR
57%
38%
Partial Response
57%
38%
NR or Progression
24%
48%
Deep Vein Thromboses
15%
2%
Granulocytopenia
0%
12%
Deaths During Treatment
6%
6%
Stem Cells Not Collected
9%
9%
Adequate Stem Cells
83%
88%
These results suggest that an entirely oral regimen of thalidomide is superior to
VAD for induction therapy for myeloma.
Comments: The most worrisome complication was deep vein thrombosis. Early
studies with the thalidomide derivative Revlimid® suggest that thrombosis is not
a major complication. The role of anticoagulation with thalidomide is
controversial.
Reference: Cavo M, Zamagni E, Tosi P, et al. Superiority of thalidomide and
dexamethasone over vincristine-doxorubicin-dexamethasone (VAD) as primary
therapy in preparation for autologous transplantation for multiple myeloma.
Blood . 2005;first edition paper, prepublished online March 10, 2005;DOI
10.1182/blood-2005-02-0522.
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These materials may discuss uses and dosages for therapeutic products that have not been
approved by the United States Food and Drug Administration. All readers should verify all
information and data before administering any drug, therapy or treatment discussed herein.
Neither the editors nor the publisher accepts any responsibility for the accuracy of the
information or consequences from the use or misuse of the information contained herein.
© 1998- 2004 CancerConsultants.com All Rights Reserved.
These materials may discuss uses and dosages for therapeutic products that have not been
approved by the United States Food and Drug Administration. All readers should verify all
information and data before administering any drug, therapy or treatment discussed herein.
Neither the editors nor the publisher accepts any responsibility for the accuracy of the
information or consequences from the use or misuse of the information contained herein.

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