This systematic review and meta-analysis evaluated seven randomized clinical trials involving 3716 patients with newly diagnosed multiple myeloma to compare quadruplet induction regimens with standard triplet therapy. The authors found that quadruplets containing an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory drug, and dexamethasone produced deeper and more durable responses. Compared with triplets, quadruplets improved overall response rates, complete response rates, stringent complete response rates, measurable residual disease negativity at both 10⁻⁵ and 10⁻⁶ thresholds, sustained minimal residual disease negativity, and progression-free survival. The analysis also suggested a possible overall survival benefit, although that finding was supported by lower-certainty evidence because follow-up is still relatively limited.

The tradeoff was higher toxicity. Quadruplet therapy increased grade 3 to 4 neutropenia, thrombocytopenia, and infections, while showing little to no difference in serious adverse events overall. The study also found that quadruplets reduced stem cell yield and increased the need for rescue stem cell mobilization, which may matter when planning transplant-based treatment. Overall, the authors conclude that anti-CD38–based quadruplets should now be considered a new frontline standard of care for many patients with newly diagnosed multiple myeloma, especially in the transplant-eligible setting. They further note that more research is still needed in high-risk disease, frail older adults, and transplant-ineligible populations.

Reference: Ebraheem MS, Chakraborty R, Rochwerg B, et al. Quadruplet regimens for patients with newly diagnosed multiple myeloma: a systematic review and meta-analysis. Blood Adv. 2024 Dec 10;8(23):5993-6002. doi: 10.1182/bloodadvances.2024014139. PMID: 39348665; PMCID: PMC11629212.

This study examined 81 affected males from 19 pedigrees with X-linked ocular albinism (XLOA) to better define the range of clinical findings. The authors found that visual acuity varied widely, even within the same family, but was often better than might be expected: nearly 80% of patients had vision of 6/36 or better, and many had good near vision. Vision did not worsen with age. Nystagmus was present in nearly all patients, strabismus was common, and refractive errors—especially astigmatism—were frequent. The study also found consistent structural eye findings, including marked iris translucency, foveal hypoplasia, abnormal foveal vascular patterns, and frequent optic disc abnormalities. Better vision tended to be associated with greater pigmentation at the posterior pole, and skin biopsies showed macromelanosomes in nearly all tested patients.

The discussion emphasizes that XLOA is often misdiagnosed, particularly as congenital motor nystagmus, and should be considered in any male infant who presents with nystagmus. The authors note that the most useful clinical clues are nystagmus, marked iris translucency, and foveal hypoplasia, though none of these findings alone are fully diagnostic. They suggest reduced vision in XLOA likely reflects multiple factors, especially foveal hypoplasia, nystagmus, and sometimes optic nerve abnormalities, with refractive error potentially contributing as well. The paper also highlights the value of examining the mother for carrier signs and using tests such as visual evoked potentials and skin biopsy to help distinguish XLOA from other inherited disorders that can present with infantile nystagmus.

Reference: Charles SJ, Green JS, Grant JW, Yates JR, Moore AT. Clinical features of affected males with X linked ocular albinism. Br J Ophthalmol. 1993 Apr;77(4):222-7. doi: 10.1136/bjo.77.4.222. PMID: 8494858; PMCID: PMC504486.

This article examines inequities in multiple myeloma care and clinical trial access, with a focus on race, age, socioeconomic status, and LGBTQ+ identity. Although treatment advances have improved outcomes overall, these gains have not been shared equally across patient groups. The paper notes that African American, Hispanic, older, and other historically underrepresented patients are still less likely to receive timely novel therapies, autologous stem cell transplant, or enrollment in clinical trials, even though outcomes are similar when access is equal. It also highlights how trial populations often fail to reflect the real-world myeloma population, especially adults over 65 and racially and ethnically marginalized groups, limiting how broadly findings can be applied.

The article argues that these disparities are driven by overlapping structural, clinical, and attitudinal barriers, including cost, travel burden, lack of nearby trial sites, strict eligibility criteria, mistrust, implicit bias, and limited provider awareness or training. It also emphasizes that LGBTQ+ patients face additional challenges related to stigma, lack of culturally competent care, and poor inclusion in cancer research. The authors recommend a broader, system-level strategy to improve equity, including provider education on implicit bias and cultural competence, more inclusive language and research practices, stronger community outreach, and expanding trial access beyond major academic centers. The overall message is that improving fairness in myeloma care and research requires shared action across clinicians, institutions, industry, and health systems.

Reference: Lu R, Tariman JD, Catamero D, et al. Diversity, equity, and inclusion in multiple myeloma: A call to action. J Adv Pract Oncol. Published online July 22, 2024. doi:10.6004/jadpro.2024.15.8.10.