Preliminary Report of Fludarabine, Mitoxantrone and Dexamethasone in Treating Refractory or Relapsed Multiple Myeloma

BACKGROUND OBJECTIVE: Multiple myeloma has low complete remission rate and high recurrence rate. Recurrence or relapse of the disease is almost inevitable for most of the patients after several cycles of combined chemotherapy. This study was designed to compare efficacy of fludarabine-based regimen (fludarabine, mitoxantrone and dexamethasone) with that of pirarubicin, vincristine and dexamethasone (VAD) on refractory or relapsed multiple myeloma, and analyze their toxicities. METHODS: Twenty-two patients who had received VAD regimen were taken as a historical control group. A total of 11 patients received FND regimen. The differences between FND group and VAD group were observed and compared. The following indexes were assessed before, during, and after treatment: the partial remission (PR) rate, total response rate, time to achieve PR, the number of patients and time of serum M-component drop to more than 50% of the pre-treatment value, the ratio of myeloma cells in bone marrow drop to less than 5% or more than 80% of pre-treatment level, and the hemoglobin level increase to more than 20 g/L; the white blood cell and platelet count of the peripheral blood, serum calcium, creatinine, β2-microglobin and glutamic-oxaloacetic transaminase (GPT) level, adverse events were also analyzed. RESULTS: The PR rate was significantly higher in FND group than in VAD group (45.5% vs. 22.7%, P0.05). The median time to achieve PR was significantly longer in FND group than in VAD group (76 days vs. 68 days, P0.05). The occurrence rates of M-component decrease and hemoglobin elevation were significantly higher in FND group than in VAD group [45.5% vs. 22.7%, and 54.5% vs. 18.2%, P0.05]. There were no significant differences in serum calcium, creatinine and GPT level pre- and post-treatment between the 2 groups. The level of serum β2-microglobin after treatment was significantly lower than that before treatment in FND group [(1 042.8±72.3) μg/L vs. (2 350.2±184.0) μg/L, P0.05]. The nadir white blood cell count was significantly lower in FND group than in VAD group [(0.9±0.46)×109/L vs. (2.09±0.6)×109/L, P0.05], and the occurrence rates of fever and cough was significantly higher in FND group than in VAD group (36.4% vs. 4.5%, 45.5% vs. 9.0%, P0.05). CONCLUSIONS: Compare with VAD regimen, FND regimen may enhance the PR rate of refractory or relapsed multiple myeloma patients, but it takes longer time to achieve PR, and shows obvious bone marrow inhibition, with no significant renal or hepatic toxicity. FND regimen is effective and safe in treating refractory or relapsed multiple myeloma.