Relapsed/refractory myeloma has a poor outcome because of multi-drug resistance, 
patient low-performance status and toxicity of conventional chemotherapy. To 
improve results, standard chemotherapeutics and drugs targeting the 
microenvironment are applied at the same time. Bortezomib, by inhibiting 
proteasome function, may enhance chemosensitivity to other drugs and overcome 
drug-resistance. Notably, doxorubicin and bortezomib may reciprocally increase 
their efficacy. Thus, to improve outcome whilst minimizing therapy-related 
toxicity, liposomal doxorubicin was added to a bortezomib-based combination. 
From January 2004, relapsed/refractory myeloma patients referred to our 
Institution received bortezomib 1.0 mg/m(2) i.v. twice weekly for 2 weeks in a 
28-d cycle for up to six cycles, oral dexamethasone 24 mg with the standard 
scheduling and thalidomide 100 mg continuously (VTD). From January 2005, 
liposomal doxorubicin, 50 mg/m(2) (30 mg/m(2) for patients older than 75 years), 
was added on day 4 of each cycle [VTD plus Myocet (MyVTD)]. In total, 70 
patients were treated: 28 received VTD and 42 MyVTD. Baseline demographic and 
clinical characteristics were similar between the two groups. Toxicity was 
manageable although more pronounced with MyVTD. The overall response rate (81% 
vs. 50%, P = 0.009), time to progression (19 vs. 11 months, P = 0.01) and 
progression-free survival (15 vs. 8 months, P = 0.001) were significantly higher 
with MyVTD regimen, suggesting an improved quality of response.