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

Consider bleeding disorders in heavy menstrual bleeding, O’Brien B et al. J Pediatr Adolesc Gynecol. 2018 Nov 22 . doi: 10.1016/j.jpag.2018.11.005

Lower-dose treatment could save money in aTTP, Zwicker JI et al. ASH 2018, Abstract 374

Low rates of bleeding with DOAC interruption, Douketis J et al. ASH 2018, Abstract LBA-5

Gene therapy in severe hemophilia B, Reiss UM et al. ASH 2018, Abstract 491

Luspatercept reduced transfusion burden in trial, List AF et al. ASH 2018, abstract 1

Must Reads in Multiple Myeloma

RNA editing contributes to myeloma pathogenesis, Teoh PJ et al. Blood. 2018;132(12):1304-17

Haploidentical allo-HCT possible even in relapsed myeloma, Sahebi F, et al. Biol Blood Marrow Transplant. 2018 Sep 20. pii: S1083-8791(18)30575-5.

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.