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Norm Macdonald's last show

He was stage-ready and planning to tape a pair of performances in Los Angeles. Then the coronavirus pandemic hit, shuttering entertainment venues across the nation. At almost the same time, Macdonald’s monthly visit to the hospital revealed that the original cancer, multiple myeloma, had metastasized into myelodysplastic syndrome, which can often lead to acute leukemia. The diagnosis left Macdonald and Hoekstra spinning and unsure of the next steps. Except for one thing: Whatever happened, Macdonald wanted to make sure his material was shown.

There are some great moments in this Washington Post article about Norm Macdonald’s last few years and his last comedy special (available on Netflix starting May 30th), but I couldn’t help noticing a factual error in their description of his medical condition. Macdonald’s multiple myeloma didn’t metastasize to MDS, but was most likely the consequence of prior myeloma treatment. High-dose chemotherapy and autologous stem cell transplantation can cause therapy-related MDS, which is difficult to treat, impossible to cure, and has median overall survival of 18 months.

So why even give this treatment, if a known toxicity is an even deadlier cancer? Because randomized controlled trials showed that people with myeloma who received it lived longer than those who didn’t. And one day, hopefully soon, a randomized trial will show that some other, less toxic treatment is even better than autologous transplantation. Which is to say, it is auto transplant and not randomization that we should strive to send to the dustbin.

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