Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

VDT PACE-Like Therapy for Relapsed/Refractory MM

Am J Hematol; ePub 2017 Nov 10; Lakshman, et al

The combination chemotherapy regimen VDT PACE and its variations are effective in patients intensely pre-treated for relapsed/refractory multiple myeloma, according to an intent-to-treat analysis involving 141 individuals. Participants had relapsed/refractory multiple myeloma and were treated with VDT PACE-like regimens (VLPRs) at a single center between 2006 and 2017. They received a median of 4 prior treatments. ~Two-thirds had prior stem cell transplant (SCT). ~Half had high-risk cytogenetics. Among the results:

  • ~7 in every 10 patients achieved ≥minimal response.
  • 54% achieved ≥partial response.
  • 1 in every 10 achieved ≥very good partial response.
  • Median progression-free and overall survival were 3.1 and 8.1 months, respectively.
  • 8 in every 10 received therapy after VPLR; 63% received systemic chemotherapy and 39% SCT.
  • Those who received SCT survived a median of 5.1 months.
  • Patients ≥60 years of age and those with R-ISS III stage experienced shorter overall survival.


Lakshman A, Singh P, Rajkumar S, et al. Efficacy of VDT PACE-like regimens in treatment of relapsed/refractory multiple myeloma. [Published online ahead of print November 10, 2017]. Am J Hematol. doi:10.1002/ajh.24954.

This Week's Must Reads

Gene sequencing bone marrow in myelodysplastic syndrome, Duncavage EJ et al. N Engl J Med 2018;379:1028-41.

Levofloxacin prophylaxis in ALL, AML , Alexander S, et al. JAMA. 2018;320(10):995-1004

Genetic markers signal poor prognosis in MCL, Obr A et al. Clin Lymphoma Myeloma Leuk. 2018 Aug 23. doi: 10.1016/j.clml.2018.07.282

Disparities in ALL treatment toxicity, Taylor OA et al. Clin Cancer Res. 2018 Sep 11. doi: 10.1158/1078-0432.CCR-18-0939

Leukemia risk after maternal contraception use, Hargreave M et al. Lancet Oncol. 2018 Sep 6. doi: 10.1016/S1470-2045(18)30479-0

Must Reads in Multiple Myeloma

Osteoporosis tied to mortality risk in women with multiple myeloma, Rosko AE et al. Clin Lymphoma Myeloma Leuk. 2018 Sep;18(9):597-602.e1.

Improved myeloma outcomes associated with having prescription drug coverage, Olszewski A et al. J Clin Oncol. 2018 Aug 16. doi: 10.1200/JCO.2018.77.8894

Simulated model could target myeloma treatment, Ubels J et al. Nat Commun. 2018 Jul 27. doi: 10.1038/s41467-018-05348-5.

Researchers propose frailty index for older patients with multiple myeloma, Mian HS et al. JCO Clin Cancer Inform. 2018 Jul 25. doi: 10.1200/CCI.18.00043.

Myeloma PFS boosted by elotuzumab add-on therapy, Dimopoulos MA et al. EHA (European Hematology Association) Congress, Abstract LB2606.