Study The study in question is the ALCYONE Trial, published in NEJM in 12 December 2017 by María-Victoria Mateos, Meletios A Dimopoulos, et al.
The investigators studied the effect of adding Daratumumab with Bortezomib, Melphalan and Prednisolone in patients with freshly detected Myeloma ineligible for Autologous Bone Marrow Transplantation.
The study arms were Arm 1: Daratumumab + Bortezomib + Melphalan + Prednisolone and Arm 2: Bortezomib + Melphalan + Prednisolone
Background Recently, I was presenting approach to Thrombotic Microangiopathy in hospital. I made the following notes, which I feel will be beneficial for the residents.
Introduction TMA are of diverse etiologies but have unified manifestation
a. MAHA (Coombs negative, increased LDH, schistocytes)
b. Thrombocytopenia
c. Organ injury (ischemic)
TMA has unified pathogenesis
a. Endothelial dysfunction
b. Microinfarcts
Approach to treatment
a. Primary TMA syndromes (ADAMTS deficiency, HUS): treatment to be of the cause