Clinical Edge

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

Reducing GI Toxicity After Melphalan/Auto-HSCT

Leuk Lymphoma; ePub 2018 Jan 2; Malek, et al

A cytoprotective agent appears to lower GI toxicity and maintain the efficacy of high-dose melphalan (HDM)/autologous hematopoietic cell transplantation (auto-HCT) in patients with multiple myeloma, according to an anlysis involving 221 individuals. Participants had multiple myeloma and were treated at either University Hospitals Cleveland Medical Center with amifostine (740 mg/m2 15 minutes before HDM; n=107) or MD Anderson Cancer Center without the agent. Among the results:

  • Amifostine was well tolerated with no significant adverse effects.
  • ≥Grade II oral mucositis occurred in 27% of patients pre-treated with amifostine, vs 47% of those who were not treated with the agent.
  • Nausea occurred in 32% and 86%, vomiting in 19% and 53%, and diarrhea in 56% and 73%, respectively.
  • Amifostine had no visible effect on engraftment, or progression-free or overall survival.

Commentary:

Malek E, Gupta V, Creger R, et al. Amifostine reduces gastro-intestinal toxicity after autologous transplantation for multiple myeloma. [Published online ahead of print January 2, 2018]. Leuk Lymphoma. doi:10.1080/10428194.2017.1408086.

This Week's Must Reads

FDA postmarketing requirements, Nabhan C et al. JAMA Oncol. 2018 May 10. doi:10.1001/jamaoncol.2018.0610.

Upswing in childhood lymphomas, Siegel DA et al. ASPHO 2018, Abstract 605.

Dapagliflozin suppresses hepcidin, Ghanim HA et al. AACE 2018, Abstract 228.

Methotrexate or nelarabine plus chemo in pediatric T-ALL or T-L, Dunsmore KP et al. ASCO 2018, Abstract 10500.

Blood type is diarrhea destiny, Kumar P et al. J Clin Invest. 2018 May 17; doi: 10.1172/JCI97659.

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 https://doi.org/10.1016/S2352-3026(18)30016-4

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