MP:
MELPHALAN 8 mg/m2 po + PREDNISONE 100 mg/day PO DAYS 1-4
NOTE: Do not use if patient considered for myeloablative therapy
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VAD:
VINCRISTINE 0.4 mg/day IV
ADRIAMYCIN 9 mg/m2/day IV
BOTH DRUGS TO BE GIVEN BY CONTINUOUS INFUSION ON DAYS 1-4, & WITH DEXAMETHASONE 20 mg/m2 ON DAYS 9-12, & 17-20.
With Spinal XRT:
DEXAMETHASONE 20 mg/m2/day PO on DAYS 1-4, 9-12, 17-20
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RESISTANT MYELOMA
Use alternatives above or
Use Thalidomide:
Thalidomide escalating dosage schedule from 200 mg to 800 mg a day.
Toxicities include: Constipation, sedation, & symptoms of peripheral neuropathy.
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Thalidomide + Decadron
Thalidomide 200 mg/day with
Dexamethasone 40 mg/day orally on days 1-4, 9-12, & 19-20 in the ODD cycles and, on the EVEN cycles, only on days 1-4
RESULTS: RR 64%. Using the cut-off level of a 25% reduction in paraprotein to define response, RR 92%. Complications: DVT in 10% of patients, constipation in 8%, & rash in 6%. Three patients died while on treatment; 1 from pancreatitis, 1 from PE, & 1 from infection.
REF: Rajkumar S, Hayman S, Gertz M, et al. Combination therapy with thalidomide plus dexamethasone (THAL/DEX) for newly diagnosed myeloma (MM). Program and abstracts of the 43rd Annual Meeting of the American Society of Hematology; December 7-11, 2001; Orlando, Florida. Abstract 3525.
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___________________________________________ Classification of plasma cell dyscrasias: MGUS --Absence of lytic lesions, anemia, hypercalcemia, renal insufficiency, & stability of the monoclonal protein during follow up. --serum monoclonal protein <3 g/dL --min or absent light chain excretion SMOLDERING MYELOMA --monoclonal paraprotein <5 g/dL --min marrow plasmacytosis <30% --mild anemai --no renal insufficiency or lytic bone lesions INDOLENT MYELOMA --Stage I multiple myeloma except patients are asymptomatic & <3 asymptomatic small lytic bone lesions. EXTRAMEDULLARY OR SOLITARY PLASMACYTOMA OF BONE PLASMA CELL LEUKEMIA ___________________________________________
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