774 Alternating VCMP/VBAP at standard doses (SD) vs. VCMP/VBAP at intermediate doses (ID) as initial treatment of multiple myeloma (MM)

Abstract

In a previous PETHEMA study we have shown that VCMP/VBAP increases response rate in MM when compared with melphalan/prednisone. The aim of the present study was to ascertain whether treatment with VCMP/VBAP (ID) with a moderate increase in the cyclophosphamide (C) and adriamycin (A) doses could be superior to VCMP/VBAP at SD. From Jan 1, 1990 through May 31, 1994, 449 pts with symptomatic MM entered the study. All patients were randomized to receive: (A) alternating courses of VCMP (vincristine 1 mg iv on day 1, cyclophosphamide 500 mg/m 2 iv on day 1, melphalan 9 mg/m 2 p.o. on days 1–4 and prednisone 60 mg/m 2 on days 1–4) and VBAP (vincristine 1 mg iv; BCNU and adriamycin iv, 30 mg/m 2 each on day 1; and prednisone 60 mg/m 2 on days 1–4, or (B) the same VCMP/VBAP increasing the cyclo from 500 to 1200 mg/m 2 and adria from 30 to 50 mg/m 2 . The objective response rate among the already evaluable pts for response was 40.2% with SD vs 50.5% with ID ( P = 0.068) with no impact on survival (31 vs 30 mos). In summary, these results show a trend towards a higher response rate to VCMP/VBAP at higher doses of cyclo and adria, with no significant impact on survival. Supported in part by Grants from FIS 95/0828 and “Fundacio Josep Carreras per a la Lluita Contra la Leucemia”.