Case report Treatment of plasma cell leukemia with vincristine, liposomal doxorubicin and dexamethasone Christou L, Hatzimichael E, Chaidos A, Tsiara S, Bourantas KL. Treatment of plasma cell leukemia with vincristine, liposomal doxorubicin and dexamethasone. Eur J Haematol 2001: 67: 51±53. # Munksgaard 2001. Abstract: Primary plasma cell (PCL) leukemia is a rare lymphoproli- ferative disorder characterized by a malignant proliferation of plasma cells in the bone marrow and peripheral blood. Survival with standard therapy using melphalan is very poor. Doxorubicin encapsulated with liposomes has less cardiotoxicity, is at least as ef®cient and has fewer side effects than conventional doxorubicin. Two female patients (69 and 54 yr old) with primary PCL are described in this study. They both received a modi®ed form of VAD (vincristine, doxorubicin and dexamethasone), a regimen which includes liposomal doxorubicin (40 mg/m 2 for 1 d), vincristine (2 mg for 1 d) and dexamethasone 40 mg per os on days 1±4, 9±12 and 17±20. A disease evaluation of the ®rst patient after six courses of the modi®ed \VAD regimen showed no plasma cells in the peripheral blood, a decrease in the serum M protein level and a plasma cell in®ltration in the bone marrow of less than 5%. The patient died from a cardiac episode 24 months post-diagnosis, while she was in complete hematological remission. The second patient also exhibited good tolerance to liposomal doxorubicin with no side effects, achieved complete haematological remission and remains in good condition 7 months after the last VAD administration. These results suggest that this modi®ed form of VAD regimen also seems to work in PCL and is well tolerated with no side effects. Leonidas Christou, Eleftheria Hatzimichael, Aristidis Chaidos, Stavroula Tsiara, Konstantinos L. Bourantas Haematology Clinic, Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece Key words: plasma cell leukemia; treatment; modi®ed VAD regimen; liposomal doxorubicin Correspondence: K. L. Bourantas, M.D., Professor of Internal Medicine-Haematology, P.O. Box 37, GR-45 002 Ioannina, Greece Tel: +30 651 24794 Fax: +30 651 39356 e-mail: kbouran@cc.uoi.gr or me00350@cc.uoi.gr Accepted for publication 12 March 2001 Plasma cell leukemia (PCL) is a very rare plasma cell dyscrasia. It mainly occurs as a terminal event in the evolution of multiple myeloma in 1±2% of cases (secondary PCL), but it can also occur as a presenting feature (primary or de novo) (1). The incidence of primary PCL is estimated to be 1.6% of all myeloma cases (2). Owing to the low frequency of this entity, most publications are based on case reports and responses are anecdotal. Therefore, treatment of PCL is dif®cult to evaluate and remains disappointing. Up to now several treatment modalities have been used. Conventional melphalan-based treatments and single agents, such as ifosfamide, cyclopho- sphamide, ¯udarabine and BCNU (carmustine), failed to improve survival rates, which do not usually exceed 7 months (3±5). More intensive therapeutic approaches, mostly used for multiple myeloma (MM), such as the VAD regimen (vincris- tine, doxorubicin and dexamethasone) are giving more promising results (3, 6). In a previous study (7) we have described encouraging results of the administration of a modi®ed VAD regimen containing vincristine, liposomal doxorubicin and dexamethasone in patients with MM. Since no treatment of choice exists for patients with PCL, we administered this modi®ed VAD in two patients with primary PCL in order to investigate the safety and probable higher ef®cacy of this treatment. Eur J Haematol 2001: 67: 51±53 Printed in UK. All rights reserved Copyright # Munksgaard 2001 EUROPEAN JOURNAL OF HAEMATOLOGY ISSN 0902-4441 51