It is the consensus opinion of the haematology reference committee that this protocol is not considered best practice for this patient population.
For many years, infusional vincristine, doxorubicin, dexamethasone (VAD) was used as pre-transplant induction therapy for patients who were candidates for AuSCT. However, disadvantages of VAD include the requirement for central venous lines, neurotoxicity, and a low CR rate of typically < 10%. VAD is therefore no longer considered the induction regimen of choice. Since the introduction of thalidomide, lenalidomide and bortezomib, many novel agent based combinations have been shown to induce a deeper response rate compared to VAD, and improve post-transplantation outcome.r Consequently, there has been a move towards incorporating novel agents into the induction regimen with the aim of increasing CR and VGPR rates post AuSCT. However, some induction regimens not containing novel therapeutic agents such as CID (cyclophosphamide, idarubicin, dexamethasone) and PCAB (doxorubicin, carmustine, cyclophosphamide, prednisolone) are also efficacious and are still currently utilised as first-line induction treatment in some Australian centres.