Teniposide, dexamethasone and continuous-infusion cyclophosphamide in advanced refractory myeloma

Twenty-one patients with advanced refractory myeloma (nine primary unresponsive to melphalan, 12 relapsed and resistant to first-line salvage therapy) received monthly 7 d courses of cyclophosphamide by continuous infusion, associated with teniposide and dexamethasone. Six patients died within 2 months from start of treatment, before receiving an adequate trial. Among the 15 evaluable patients, there were eight objective responses and three improvements (decrease of monoclonal protein greater than 50% or greater than 30%, respectively). After a median follow-up of 10 months, all responding patients are alive and none of them is still relapsed. In heavily pretreated patients, ineligible for more aggressive approaches, cyclophosphamide by continuous-infusion exerted a good antineoplastic activity without increasing toxicity.