Intermediate doses of melphalan and dexamethasone are better than vincristine, adriamycin, and dexamethasone (VAD) and polychemotherapy for the treatment of primary plasma cell leukemia

Primary plasma cell leukemia (PPCL) is a rare form of disease accounting for 1-2 percent of myelomas. Between September 1990 and November 2000, among 540 patients with myeloma studied, 24 fulfilled the criteria of PPCL (4.4 percent). We found high frequencies of female patients (62 percent), Bence J...

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Bibliographic Details
Published in:Annals of hematology 2002-07, Vol.81 (7), p.362-367
Main Authors: VELA-OJEDA, J, GARCIA-RUIZ ESPARZA, M. A, ROSAS-CABRAL, A, PADILLA-GONZALEZ, Y, GARCIA-CHAVEZ, J, TRIPP-VILLANUEVA, F, SANCHEZ-CORTES, E, AYALA-SANCHEZ, M, GARCIA-LEON, L. D, MONTIEL-CERVANTES, L
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic agents
Antineoplastic Agents - administration & dosage
Antineoplastic Agents, Alkylating - administration & dosage
Antineoplastic Agents, Hormonal - administration & dosage
Antineoplastic Agents, Phytogenic - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
Chemotherapy
Dexamethasone - administration & dosage
Dose-Response Relationship, Drug
Doxorubicin - administration & dosage
Female
Hematologic and hematopoietic diseases
Humans
Leukemia, Plasma Cell - drug therapy
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Male
Medical sciences
Melphalan - administration & dosage
Middle Aged
Pharmacology. Drug treatments
Photochemotherapy
Survival Analysis
Treatment Outcome
Vincristine - administration & dosage
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Summary:Primary plasma cell leukemia (PPCL) is a rare form of disease accounting for 1-2 percent of myelomas. Between September 1990 and November 2000, among 540 patients with myeloma studied, 24 fulfilled the criteria of PPCL (4.4 percent). We found high frequencies of female patients (62 percent), Bence Jones proteinuria (79 percent), anemia (88 percent), bleeding (54 percent), confusional syndrome (42 percent), weight loss (71 percent), hepatomegaly (25 percent), splenomegaly (21 percent), leukocytosis (62 percent), and thrombocytopenia (71 percent). High serum levels of creatinine, calcium, lactate dehydrogenase (LDH), and beta(2)-microglobulin were detected in 50 percent, 37 percent, 58 percent, and 71 percent, respectively. Four patients were treated with vincristine, melphalan, cyclophosphamide, prednisone, and adriamycin (VMCPA), 12 with vincristine, adriamycin, and dexamethasone (VAD), and 8 with M-80 (oral melphalan 80 mg/m(2) plus dexamethasone 40 mg/m(2)). There was a trend toward lower values of Karnofsky score (P=0.07) and higher values of LDH (P=0.2) in the VAD group. Other clinical characteristics were comparable among the three groups. Complete plus partial responses were achieved in one and six patients treated with VMCPA and M-80, respectively. All patients treated with VAD failed to respond to treatment. Patients receiving the M-80 regimen experienced higher platelet toxicity (P=0.05), vomiting (P
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-002-0480-5