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

Immune system changes play a role in AML relapse, Christopher MJ et al. N Engl J Med. 2018 Oct 31. doi: 10.1056/NEJMoa1808777.

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.

Venetoclax plus HMA studied in AML, DiNardo C et al. Blood. 2018 Oct 25. doi: 10.1182/blood-2018-08-868752.

The role of PTPN22 R620W in CLL, Leukemia & Lymphoma 2018

Must Reads in Myelodysplastic Syndrome

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

JAK1/2 inhibitors tied to increased B-cell lymphoma risk, Porpaczy E et al. Blood. 2018 Jun 14. doi: 10.1182/blood-2017-10-810739.

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