Vincristine, adriamycin andhigh dosesteroids inmyeloma complicated by renal failure

(Forgeson, 1988), isrecognised tobe effective therapy inmyeloma andtobecapable ofcausing a rapid reduction inparaprotein inresponding patients. In viewofthese findings wehaveevaluated theuseofsuch treatment ineight patients withmyeloma complicated by renal failure whichhadnotresponded torehydration. The purpose ofthestudy wastoestablish, first, whether this treatment iseffective therapy inthis poorprognosis group and, second, whether itcanbegiven withacceptable toxicity. Theeight patients, meanage62,range49-77, allhad myeloma asdefined bywidely accepted criteria (MRC,1980) andrenal failure fromthetimeofpresentation (median creatinine 496tsmolI 1,range212-1,170). Fourhadrenal biopsies whichallshowedfeatures ofmyeloma kidney and fourrequired urgent dialysis atpresentation. Fourpatients hadbeengiven other chemotherapy before receiving VAMP/ VAD (Table I)butonlyonehadresponded tothis. Thechemotherapy given wasasfollows. VAMP:vincristine0.4mgandadriamycin (doxorubicin) 9mgm-2i.v. in