BACKGROUND In recent years the popularity of VAD has been tempered but we believe it still has a role in a particular patient group. The aim of our study was to demonstrate if lower doses of drugs in VAD could reduce toxicity without affecting efficacy. METHODS From January 1997 to January 2007, 56 previously untreated multiple myeloma patients were treated with ‘modified VAD’: a continuous infusion of Vincristine (0.4mg/sqm)and Doxorubicin (9mg/sqm) on days 1 to 3 and Dexamethasone 40mg for 5 consecutive days (iv on days 1 to 3 and then orally on days 4 and 5). RESULTS According to the Bladé et al. criteria, the overall response rate (CR, nCR, VGPR, PR) was 60%: CR and nCR10%, VGPR and PR 50%, SD 40%. This regimen was well tolerated.CONCLUSIONS In our experience, the modified VAD maintains its validity in older untreated or relapsed patients. However in light of newer thalidomide-based combination therapies, which have higher response rates and are better in mobilizing stem cells the role of VAD has changed.

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