Avoiding intermittent highdose dexamethasone (HD) when administering the vincristine/ doxorubicin/dexamethasone (VAD) regimen can reduce the risk for bacterial infection in patients with multiple myeloma (MM), suggest the results of a Japanese study published in the January issue of the International Journal of Hematology.
Although the VAD-HD combination is often used as primary therapy in MM patients who are candidates for high-dose therapy or present with renal failure, the high doses of a glucocorticoid can suppress their immune system, placing them at high risk for bacterial infections. To test if the VAD regimen could be equally effective without the HD component (and thus reduce patients’ risk for infection), the researchers retrospectively evaluated MM patients receiving VAD with or without HD. In the VAD group (n = 37), patients were treated in two to four 21-day cycles on days 1 to 4. In the VAD-HD group (n = 40), patients underwent the same dosing schedule plus intravenous dexamethasone on days 9 to 12 and 17 to 20 of each 28-day cycle.
The researchers identified 48 infection episodes, including pneumonia, urinary tract infections, and staphylococcus infections, in 39 patients. Of these, 32 episodes in 26 patients were grade 3. Analyzing each patient, they found VAD-HD to be associated with risk of all-grade and severe bacterial infection; ISS stage ≥2 independently correlated with severe bacterial infection.
No statistically significant differences in overall response rates were found; 62.9% in the VAD group versus 50% in the VAD-HD gro