Two Cycles of PAD Combination by AHCT in MM

1.PAD combination chemotherapy

• Bortezomib 1.3 mg/m2 will be given by intravenous bolus injection on days 1, 4, 8, 11 of each cycle. Oral or intravenous dexamethasone 40 mg will be administered on days 1-4 and 8-11 with doxorubicin 9 mg/m2 by intravenous bolus on days 1-4 of each cycle. The cycle will be repeated every 3 weeks. A total of 2 cycles is planed before AHCT.
• For mobilization, G-CSF 10ug/kg/d alone will be given by subcutaneous injection from day 12 of the second PAD cycle until completion of harvesting.

Melphalan 100 mg/m2/day will be administered on day -3 and day -2 for high-dose chemotherapy.

-Maintenance :Thalidomide 100 - 200 mg/d for 2 years

Inclusion criteria

• Patients with newly diagnosed symptomatic MM (see Appendix I)
• Patients should be eligible for AHCT.
• Patients should have measurable serum or urine paraprotein.
• The performance status of the patients should be 70 or over by Karnofsky performance scale
• Adequate hepatic and renal function: serum bilirubin < 1.5 x the upper limit of normal (ULN), serum alanine aminotransferase (ALT)/aspartate aminotransaminase (AST) values < 2.5 x ULN, serum creatinine < 1.5 x ULN
• Adequate cardiac function: ejection fraction > 40% by echocardiogram or radionuclide heart scan

Exclusion criteria

• prior chemotherapy for myeloma except 4 days of dexamethasone up to 40 mg per day or localized radiotherapy or plasmapheresis for the treatment of clinically significant hyperviscosity syndrome
• have a peripheral neuropathy of grade 2 or more within 14 days of enrollment.
• significant infection