Clinical Edge

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

High-Dose Therapy+ASCT in Multiple Myeloma Studied

JAMA Oncol; ePub 2018 Jan 4; Dhakal, Szabo, et al

High-dose therapy with melphalan+autologous stem cell transplant (HDT/ASCT) resulted in better progression-free survival than standard dose therapy (SDT) in patients with multiple myeloma, according to a meta-analysis of 9 studies involving nearly 6,000 individuals. Investigators included studies comparing single HDT/ASCT with SDT using novel agents. They looked at progression-free and overall survival, complete response, and treatment-related mortality. Among the findings:

  • Patients receiving HDT/ASCT were 27% more likely to experience complete response than those receiving SDT.
  • HDT patients experienced better progression-free and overall survival.
  • Patients receiving tandem HDT/ASCT experienced the most favorable progression-free survival, followed by single HDT/ASCT with bortezomib, lenalidomide, and dexamethasone; and single HDT/ASCT alone.
  • No HDT/ASCT-based approach significantly impacted overall survival.
  • HDT/ASCT treatment-related mortality was minimal.


Dhakal B, Szabo A, Chhabra S, et al. Autologous transplantation for newly diagnosed multiple myeloma in the era of novel agent induction: A systematic review and meta-analysis. [Published online ahead of print January 4, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2017.4600.

This Week's Must Reads

Widespread Zika screens not cost effective, Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977

New cancer drugs linked to fewer arrhythmias, Nickel A et al. annual meeting of the American College of Cardiology ACC 18, Abstract #900-06.

Good ALL outcomes in Down syndrome children, Maloney K et al. ASPHO 2018, annual meeting of the American Society of Pediatric Hematology/Oncology Abstract PP 2001

Reducing morbidity in postpartum hemorrhage, Smith R et al. Annual clinical and scientific meeting of the American Society of Obstetricians and Gynecologists 2018, Abstract 26R.

In sickle cell, start hydroxyurea in infancy, Schuchard S et al. ASPHO 2018, poster # 342 Schuchard S et al. ASPHO 2018, poster # 342.

Must Reads in Myelodysplastic Syndrome

Romiplostim safety confirmed in thrombocytopenic patients with low-risk myelodysplastic syndromes, Kantarjian H et al. The Lancet Haematology March 2018, Pages e117-e126

Simplifying the URD Selection Process for HCT, Biol Blood Marrow Transplant.; ePub 2018 Feb 14; Shaw, Logan, et al

Genetic Risk Model for MDS Shown to Be Feasible, Am J Hematol; ePub 2018 Feb 24; Gangat, et al

This Predicts Risk of Early Relapse, Death in MM , Biol Blood Marrow Transplant; ePub 2018 Feb 23; Cowan, et al

Undertreatment of Newly-Diagnosed MM Evaluated, Clin Lymphoma Myeloma Leuk; ePub 2018 Feb 3; Fakhri, et al