Clinical Response to Unintended Infusion of Doxorubicin and Vincristine
Clinical Response to Unintended Infusion of Doxorubicin and Vincristine
A standard treatment for relapsed multiple myeloma is a regimen of vincristine, doxorubicin, and dexamethasone. Abbreviated VAD (with A for the Adriamycin brand of doxorubicin), the regimen consists of vincristine sulfate 0.4 mg/day and doxorubicin hydrochloride 9 mg/m 2 / day, both given by continuous intravenous infusion on days 1 through 4 of each 28-day treatment cycle, and dexamethasone 40 mg/day orally on days 1 through 4, 9 through 12, and 17 through 20 of each odd-numbered 28-day cycle and days 1 through 4 of each even-numbered 28-day cycle. Although VAD does not yield improved survival compared with the standard melphalan and prednisone regimen in patients with newly diagnosed multiple myeloma, it is often used as initial therapy if these patients are candidates for peripheral blood stem-cell transplantation combined with high-dose chemotherapy, since VAD produces faster responses than melphalan-prednisone and minimizes the risk of permanent injury to normal hematopoietic stem cells.
VAD was originally conceived of as an outpatient chemotherapy regimen. The continuous infusion schedule was based on the growth kinetics of human myeloma cells and the greater reduction in myeloma cells grown in tissue culture after prolonged, as opposed to brief, exposures to vincristine. Because of the small volumes of medication required, the entire 96-hour supply of vincristine and doxorubicin can easily be dispensed in a portable infusion pump; stability data support this practice.
We report the case of a patient with multiple myeloma who received her entire 96-hour supply of vincristine sulfate (1.6 mg) and doxorubicin hydrochloride (36 mg/m 2 ) over 24 hours because an incorrect infusion rate was set on her portable infusion pump.
A standard treatment for relapsed multiple myeloma is a regimen of vincristine, doxorubicin, and dexamethasone. Abbreviated VAD (with A for the Adriamycin brand of doxorubicin), the regimen consists of vincristine sulfate 0.4 mg/day and doxorubicin hydrochloride 9 mg/m 2 / day, both given by continuous intravenous infusion on days 1 through 4 of each 28-day treatment cycle, and dexamethasone 40 mg/day orally on days 1 through 4, 9 through 12, and 17 through 20 of each odd-numbered 28-day cycle and days 1 through 4 of each even-numbered 28-day cycle. Although VAD does not yield improved survival compared with the standard melphalan and prednisone regimen in patients with newly diagnosed multiple myeloma, it is often used as initial therapy if these patients are candidates for peripheral blood stem-cell transplantation combined with high-dose chemotherapy, since VAD produces faster responses than melphalan-prednisone and minimizes the risk of permanent injury to normal hematopoietic stem cells.
VAD was originally conceived of as an outpatient chemotherapy regimen. The continuous infusion schedule was based on the growth kinetics of human myeloma cells and the greater reduction in myeloma cells grown in tissue culture after prolonged, as opposed to brief, exposures to vincristine. Because of the small volumes of medication required, the entire 96-hour supply of vincristine and doxorubicin can easily be dispensed in a portable infusion pump; stability data support this practice.
We report the case of a patient with multiple myeloma who received her entire 96-hour supply of vincristine sulfate (1.6 mg) and doxorubicin hydrochloride (36 mg/m 2 ) over 24 hours because an incorrect infusion rate was set on her portable infusion pump.
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