• Frederico Luiz Dulley, Rosaura Saboya, Vânia Tietsche de Moraes Hungria, Nadjanara Dorna Bueno, Fernando Gomes de Mello, Maria Tereza Frota, Carlos Sergio Chiattone, José Carlos Barros, Nair Sumie Mori, Daniel Sturaro, Maria Cristina Martins de Almeida Macedo, Roberto Luiz da Silva, Leila Maria Magalhães Pessoa de Melo, and Cármino Antonio Souza.
• Hospital Sírio-Libanês, São Paulo, Brazil. fldulley@usp.br
• Sao Paulo Med J. 2005 Nov 3; 123 (6): 266270266-70.

Context And ObjectiveLiposomal daunorubicin has been used to treat hematological malignancies, including multiple myeloma (MM). The goal was to evaluate efficacy, side-effects and toxicity of liposomal daunorubicin and dexamethasone ("DD Protocol").Design And SettingProspective study at Sírio-Libanês, São Camilo, Brasil and Alemão Oswaldo Cruz hospitals.MethodsTwenty consecutive patients with active MM received four cycles of liposomal daunorubicin intravenously for two hours (25-30 mg/m(2)/day) on three consecutive days per month, with oral dexamethasone (10 mg every six hours) on four consecutive days three times a month.ResultsThe male/female ratio was 1:1 and median age 60. Nine patients were stage IIA, ten IIIA and one IIIB. The median from diagnosis to starting DD was 13 months. All patients received four cycles, except one. Fifteen had already received chemotherapy before DD. Responses of > 50% reduction in serum monoclonal paraprotein were observed in six patients after first cycle (30%), six after second (30%) and four after third (20%), while four (20%) did not obtain this. Initially, 17 patients (85%) had anemia: 12 (70%) achieved correction. Progressive disease was observed in three patients (15%), while one had minimal response, four (20%) partial and 12 (60%) complete. Hematological toxicity was acceptable: three patients (15%) had neutrophils < 1,000/mm(3); none had thrombocytopenia. Gastrointestinal toxicity was mild: nausea (10%), anorexia (15%) and no vomiting.ConclusionsThis treatment has mild toxicity and good response rate. It may therefore be feasible before autologous bone marrow transplantation.

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